Registration

CENTRAL TEXAS SPORTS MEDICINE SYMPOSIUM
COURSE REGISTRATION

Advance registration is requested. Fees are $130 ($150 after June 1, 2008) for athletic trainers, physical therapists, physical therapist assistants, coaches and others.

Fees include daily continental breakfast, lunch (Friday only), and course syllabus. Canceled registrations will be refunded if received prior to June 1, 2008. A $35 handling charge will be deducted.

The Central Texas Sports Medicine Symposium has reserved the right to limit registration and change any course curriculum no less than one week prior to the event. Should unforeseen circumstances require cancellation, tuition will be refunded in full. The Central Texas Sports Medicine Symposium is obligated to refund tuition only.

To register by mail, please fill out the registration form and send to the address listed at the bottom of the form.

June 13-14, 2008

Thompson Conference Center

University of Texas at Austin

Please print or type:

Name:______________________________________________

License Number:______________________________________

Contact Phone:_______________________________________

Profession: Athletic Trainer______ Physical Therapist_______

Physical Therapist Assistant______ Coach______ Other______

Address:_____________________________________________

City, State, Zip:________________________________________

Email:_______________________________________________

Federal Tax ID:________________________________________

(if company pays fee)

 

FEES:

_____ $130 (late fee after June 1, 2008: $150) Athletic Trainer, Physical

Therapists, Physical Therapist Assistants, Coaches, Other

Pay by Credit Card:

Master Card______ Visa______

4% convenience fee applies if paying by credit card

Name on Card:_________________________________________

Card Number:__________________________________________

Expiration Date:________________________________________

Signature:_____________________________________________

Pay by check

 

: Please make checks payable to

LTISDMail to

 

: LTISD / Ashley Bernard / 3324 RR 620 South / Austin, TX 78738