Registration Form

Personal Information
* First Name:
* Last Name:
Title:
* Home Address:
* Home City:
* State:
* Zip Code:
* Home Phone:
* Email Address:
PT/PTA License #(s) & State(s):
NATA Cert #:
NSCA/ACSM Cert #:
APTA Member:
T-Shirt Size:
I Would Like my Confirmation/Reciept Sent To My:
How Did You Hear About This Conference?
  if "Other":


Company Information
Company Name:
Company Address:
Company City:
Company State:
Company Zip Code:
Company Phone:


Breakout Sessions

Breakout sessions are available to participants at an additional fee of $30.00 per breakout session. Each breakout session will be approximately one hour in length.

Breakout sessions are limited to 35 participants (which will be strictly adhered to) and are on a first come, first served basis.

NO CHANGES WILL BE MADE TO BREAKOUT SESSION ASSIGNMENTS AFTER OCTOBER 1, 2008.

Day 1 - Foot, Ankle & Knee

4:00 PM - Breakout Session 1

5:00 PM - Breakout Session 2

Day 2 - Hip & Lumbar Spine

4:00 PM - Breakout Session 1

5:00 PM - Breakout Session 2

Day 3 - Cervical Spine & Shoulder

4:00 PM - Breakout Session 1

5:00 PM - Breakout Session 2


Reception Guests

Day One’s Outdoor Dinner Reception is included for all registrants. Guests of registrants are welcome to attend at an addional fee of $50 per guest.

# of Guests for Reception ($50 each)


Drayer Physical Therapy Institute® Privacy Statement

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Questions?

Contact Drayer
for more information

717-220-2100

8205 Presidents Drive, 2nd Floor, Hummelstown, PA 17036




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