Please be sure to submit your dossier, copy of license and APTA card (if applicable) in addition to payment!
Long Beach Memorial Medical Center
Valerie Teglia, PT, DPT
May 18-19, 2019 (Saturday-Sunday)
To register, each participant must submit:
1. Dossier typewritten. (download form here CCIP Participant Dossier Form) APTA WILL NOT ACCEPT HANDWRITTEN DOSSIERS.
2. Copy of state license to practice
3. Copy of current (as of date of course) APTA membership card, if applicable.
4 Registration fee-- check payable to IACCC, or payment on IACCC website via Paypal.
IACCC Affiliate Facility members
$200 (APTA member)
$325 (non APTA member)
Non-IACCC Facility Members
$300 (APTA member)
$425 (non APTA member)Email or fax all registration materials to:
IACCC CCIP Administrator
1540 East Alcazar Street, CHP-155K
Los Angeles, CA, 90089-9006
Registration & payment must be received by: April 24, 2019
Your spot in the course cannot be guaranteed until payment and a completed dossier are received. Only those persons who receive a confirmation of their registration by e-mail will be considered to be enrolled.Refunds and Cancellations
Cancellations must be received in writing, and will be granted a full refund until April 24, 2019. Cancellations received after 4/24/2019 and up to 5/10/19 prior to the course will receive a refund, minus a $75 processing fee. Cancellations received 5/10/19 or later are not eligible for a refund.