NAIOMT Course Registration  
   
  Please read the NAIOMT Privacy Policy.
   
 

Please note: online course registration is a three step process.

1) Provide us your information below and select course(s) to register for. When you have submitted this information, you will be provided a link to pay for course registration.

2) Pay for your course registration.
Course registration is not complete until payment is received!

3) Receive final registration confirmation from the course site.
Final registration confirmation will come from the host course site. Please note that courses may fill up - if so, registrants will be placed on a waiting list. The host course site will communicate this information to the registrant.
 
Site Information
Address

Providence Medford Medical Center
Outpatient Orthopedic Gym
1111 Crater Lake Avenue
Medford, OR 97504
541-732-8280
 
Course Times
8am to 6pm, each day
 
Select Course
625 - Extremity Course Manipulation by Bill Temes- $470
Not signing up for this course.
February 11-12, 2012
 
Lab Assistants
I understand the following requirements for lab assisting for a NAIOMT core or specialty course(s): To lab assist for a course I must be a registered/pre-approved lab assistant who has completed the lab assistant application and provided the required documentation prior to the course taking place. If I'm considering lab assisting, I will contact the Site Coordinator for permission from both the Site Coordinator and the Faculty-Instructor of the NAIOMT course(s) I'm wanting to lab assist. Lab Assisting is not a guaranteed position. Please request from the Site Coordinator the Lab Assistant Application.
I understand the above, and I am registering for this course as a lab assistant:
Note: you must have approval from both the site coordinator and the instructor to register as a lab assistant.
 
Faculty Instructor-in-Training
I will be attending this course as a Faculty Instructor-in-Training with the permission of the course instructor.
 
 
Student Info
*NAIOMT ID:  
  Your NAIOMT ID is your first and last initial and the last 4 digits of your social security number.  For example Jane Doe whose SSN is 123-45-6789 would have a NAIOMT ID of jd6789
*Name:  
Different last name (eg. Maiden):
Name desired on certificate, if applicable:
Other name (prior name, maiden name, nick name):
 
PT Info
*PT License #:
*PT License Exp Date:
*PT License State:
I hereby certify the PT license and information I have provided is true and accurate:
I hereby certify that I am a third year physical therapy student:
 
Contact Info
  Home / Personal Employer Name:
*Address:
 Work Address:
Add, line 2: Work Add, 2:
*City:
 Work City:
*State:
 Work State:
*ZIP:
 Work Zip:
Country: Work Country:
       
*Phone:
(xxx) xxx - xxxx		 Work Phone:
(xxx) xxx - xxxx
*Email: Work Email:
Fax: Work Fax:
Email Preference: Home Work    
       
 
Training Info
*University / College Name :
*State:
*Country:
*Year of PT graduation:
*Degree earned:
 
Course Confirmation

I understand that course registration confirmation will come from the course site that I have selected to attend, and in some cases from NAIOM directly. I will be notified by the course site whether or not I will be participating in the course or if I have been placed on a waiting list. If I do not hear from the course site within 10 business days I will contact, admin@naiomt.com
 
Cancellation Policy

NAIOMT will refund course tuition minus an administrative fee of $50 if written notification is received 1 (one) month prior to the start of the course. No refunds are granted after that date, but a credit, minus a $50 processing fee, for future NAIOMT sponsored courses, is given.  Credit for a future course is good for one (1) year from the date of the written cancellation notice.

NAIOMT reserves the right to cancel the course up to 30 days prior to the start date for a full refund due to low enrollment.  In the event of circumstances beyond the control of NAIOMT or INSTRUCTOR, such as natural disaster, severe illness, civil disorder, or unavoidable mishaps en route to the course (in each case substantiated by evidence reasonably acceptable to the other party), full refund is given. NAIOMT is not responsible for personal costs incurred or reimbursement of travel arrangements in the event a course is cancelled or postponed or the dates are changed.

Final confirmations will be emailed 30 days prior to the course date.  NAIOMT recommends that participants of a course wait until receipt of the final confirmation to book travel arrangements.

 
Authorize and Submit

The following electronic affirmation and date verify I acknowledge and agree that:

I have read and agree to the conditions of the course(s) as noted above in the course registration.

I wish to apply for the course(s) indicated above, and I will pay all fees for courses I am taking.

I hereby certify the information I have provided is true and accurate and I am a currently licensed physical therapist in good standing or a third year physical therapy student.
 
*Agreed
 *Date
 
Please note that discount fee is not applicable unless your sponsor has contacted NAIOMT regarding your sponsorship. Be sure this occurs prior to submitting your course registration and payment.