Please provide the following contact information: An asterisk (*) indicates a required field. The Ertl Symposium to be held on April 18th and 19th is listed under the priorities below as "23 - Amputation - 4/18 & 19".
*First Name
*Last Name
Discipline
*Mailing Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Daytime Phone
Fax Number
Priority 1
Code None 01: Course 2: Spinal Manipulation - March 6 & 7 03: Course 3: Spinal Manipulation - March 8 & 9 10: Woundcare - Ongoing 11: Neurological Hand - Ongoing 12: Hand Eval & Treatment - Ongoing 13: Trauma Disorders - Ongoing 21: Aging in Place - 3/11 44: Ethics - 4/7 22: Clin Ed - 4/11 & 4/12 23: Amputation - 4/18 & 4/19 24: Manual Therapy - 4/19 25: Pelvic Floor - 4/21 27: Gait - 5/13 26: Pre/Post Partum - 6/2 31: Evidence Based Differential Diagnosis - 6/28 32: Ethics II - 8/5 34: Lumbopelvic Stability - 9/13 33: Ethics III - 9/15 35: Manual Therapy II - 9/27 36: Autism - 9/30 37: Visual System - 10/4 38: Motivation - 10/21 39: Sensory - 11/8 40: Mental Health - 11/18 41: Seating & Mobility - 11/22 42: Partnership - 12/8
Priority 2
Priority 3
Priority 4
Priority 5
Priority 6
Check (Please mail check with a completed copy of this form and any additional documentation)
Mailing Address: OUHSC Department of Rehabilitation Sciences Attn: Katy Wandel 801 NE 13th St., Room 235 Oklahoma City, OK 73104 Questions? Call Katy Wandel at (405) 271-2131 ext. 47130 | Fax: (405) 271-2432
PLEASE PRINT THIS FORM PRIOR TO SUBMITTING!
A confirmation will be sent via email once payment is received. Thank you!
For additional information, please contact: Katy Wandel or call (405) 271-2131 ext. 47130