Conference Registration Form – ONE COURSE

Please fill out the following information and then click “Continue to Payment.”  You will then be redirected to our credit card payment processor, PayPal.

If you have any questions about registering for this course please contact Nicole Kinney, HAPTA Executive Director at or (800) 554-5569 x13. Thank You!

MEMBER RATES: All APTA members are eligible for discounted member rates, regardless of chapter membership. You must be a member in good standing as of the date of the conference to be eligible for all member rates. Registrants who have a membership expiration date prior to the conference must provide proof of membership renewal before the conference begins or they will be subject to paying the nonmember rate. New APTA members who do not yet have a member number must submit a copy of their membership application form or emailed confirmation to receive the member rate. OTs and OTAs may register for courses at the member rate only if proof of AOTA membership accompanies their registration form or is received via email to prior to the conference OTs and OTAs who do not provide proof of membership prior to the conference will be subject to paying the nonmember rate.

CANCELLATIONS & SUBSTITUTIONS: To cancel, email HAPTA at or call (800) 554-5569 x113. Cancellations received by March 10, 2019 will receive a full refund minus a $25 cancellation fee. Cancellations received between March 10 and March 22, 2019 will receive a 50% refund. There will be no refunds after March 22, 2019. Unless there is a waiting list for the course, substitutions will be accepted at no charge until March 22, 2019. All substitutions must be for the same member type and rate and are at the discretion of HAPTA chapter staff. No substitutions will be accepted after March 22, 2019 or if the course has a waiting list.

2019 HAPTA Spring Conference Course Registration Form
Concussion Evaluation and Management: Implications for Physical Therapists - Anne Mucha PT, DPT, MS, NCS

Registrant Name
APTA Member?
Type PT
APTA Member Number If applicable.
TOTAL COST:     Please select membership type.
Contact Information:
Registrant Address:
Registrant City, State Zip:
Registrant Phone:
Registrant Email:
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