Course Registration

Please provide the following contact information: 

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Choose one of the following options: 

ABC Certified Practitioner State Licensed Practitioner NCOPE Resident BOC Certified Certified by the foreign country in which you reside

Choose one of the following options:

          CO CP CPO

Are you bringing a Technician? 

Yes No

If yes, please fill out Technician information:

Name
Title

Course Date: If the course you would like to sign up for is not listed, then you must register for that course through the conference that it will be held at.

  December 6, Little Rock

Course location, hotel  information, and itinerary  will be faxed to you, within 24 hours,  after your registration is received.

Questions or comments:

Technicians will not be authorized to purchase, they will receive a certificate of attendance.

Total Cost:  Practitioner  $295.00
                   Practitioner / Tech  $395.00