Hesch Institute Seminar, Course & Workshop Registration

Hesch Institute Workshop Registration

Please read the workshop brochure, and then fill out the form below to register. The registration form can also be printed from the brochure and emailed, faxed, or mailed. Please see the contact page for mailing address, fax, and phone number.
Items marked with * are required

* Indicates required field

I Am Registering For the Following Workshop: *

Name *

First

Last

Degree/s for certificate (PT, LMT, etc) *

States in which you're licensed *

Facility *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Is The Above Address: *

Home Office

Email *

Home Phone *

Work Phone *

Cell Phone *

Best Phone # to Call *

FAX *

How did you hear about us? *

Brochure APTA website E-Mail Invite Other

If other, please specify *

Cancellation Policy

No refunds after the deadline listed on the brochure (usually 5-7 days prior to the workshop). Cancellations prior to the registration deadline will receive a refund, less $50 for administrative costs. Cancellations after the deadline will receive credit for a future workshop or Distance Learning.

I have read the Cancellation Policy and agree to all terms and conditions therein. *

I Agree

Step 1 - REGISTER

Step 2 - Secure Pay Now