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2020 Physician Assistant / Physical Therapist Application for the Healer's Art FDW Training

2020 Physician Assistant/Physical Therapist Application for the Healer’s Art FDW Training

1. Name and Education History *This question is required.
2. School where you will teach The Healer's Art *This question is required.
6. Professional Position *This question is required.
Professional Position (if more than one held concurrently)
7. Work Contact Information *This question is required.
8. Home Contact Information
9. Which is your preferred email? *This question is required.
14. What institutional support do you have for this plan?
CME credit information for this workshop will be forthcoming.
CANCELLATION & REFUND POLICY: A deposit of $300 is due at time that your application is accepted. The balance is due by June 1, 2018. A full refund of deposit (less processing fee of $25) will be issued for cancellations on or BEFORE July 1. Cancellations after July 1 will forfeit deposit.