DiSepio Institute

DiSepio Symposium Online Registration Form

Saint Francis University - 108 Franciscan Way, Loretto, PA
Friday, June 30, 2017
Official Online Registration

Registration Information

Registrant Contact InformationPlease provide us with the following information to identify the registrant. Fields marked with * are required.

First Name: *
Middle Initial:
Last Name:
Address:
Address 2:
City: *
State: *
Zip: *
Email:
*
Phone:
Fax:
Special Needs (dietary, access, etc.)

Continuing EducationPlease indicate if you wish to receive continuing education credits:

APTA I do not need CEUs

Conference registration fee $125.00 per attendee (1-day event).

Registration includes the availability of 6.5 hours of PT/PTA credits as well as continental breakfasts and lunch.

Call (814)472-3923 with any questions.

Registrations will be accepted until June 23, 2017.  Payments must accompany all registration forms; those without complete payment will be returned.  Cancellations received prior to June 23, 2017 will receive a full refund less a $20 administrative charge.  No refunds will be made for cancellations received after June 23rd.

The DiSepio Institute may cancel or postpone any session.  If the program is cancelled or postponed, the DiSepio Institute will refund registration fees but it is not responsible for any related costs, charges, or expenses.  Preregistered participants will be notified if a program is cancelled.  Continuing Education Units will not be available after the date of the conference.