Register Secure On-line

Please complete all information below, then click Submit to transmit your registration electronically to the APTA/Colorado Chapter. A confirmation page will appear if your registration was transmitted successfully. If not, it may be necessary to re-submit your registration via fax to 303-694-4869.

A confirmation notice will be emailed to all registered practices on the Friday before the session.

Registration fees are based per-dial-in connection; multiple dial-ins from your practice will be charged. We are unable to accommodate more than one practice or department per call-in. 

Written requests for refunds received on or before the deadline for the session will receive a 50% refund, less a $50 processing fee; fees are nonrefundable after this date. There are no refunds for no shows.

You must contact us by the session deadline date if you have special needs or require additional assistance or accommodation to participate in this audio conference.

Practice/Facility Name

Contact Person

Address

City, State, Zip code

Phone

Fax

Email*
                   *Your confirmation will be sent via email.

Number of participants expected to attend from your practice

Registration Fee
The fee includes one dial-in connection. Additional fees will be charged if there are multiple dial-ins.

Select Your Session(s) -- Register for more than one
and save $$$:

Tuesday, November 11, 2008; Establishing a Fee Schedule for Your Facility
(register by Nov. 4, 2008)

Tuesday, November 18, 2008; Determining Your Cost per Visit 
(register by Nov. 11, 2008)

One Session Pricing:

$149 for Practices with 4 or more PTs on staff

$139 for Practices with 2-3 PTs on staff

$129 for Practices with only one PT on staff

Two Sessions Pricing (with discount):

$289 for Practices with 4 or more PTs on staff

$269 for Practices with 2-3 PTs on staff

$249 for Practices with only one PT on staff

Payment

VISA

MasterCard

American Express

Check payable to APTA/Colorado Chapter 
      Your check is due within 5 business days of online registration.

Purchase Order include reference number

Cardholder name

Card number include dashes

Expiration date

If paying by credit card, a receipt will be mailed to the contact person and address listed above.

Comments?

If you receive an error message after clicking below, please click your "back arrow" button which will return you to your registration page. Print your registration and fax to 303-694-4869. Please note, if you receive the error message and have to register by fax, your credit card will NOT be charged twice.