SPORTS MANUAL THERAPY CERTIFICATION (SMTC)

SPORTS MANUAL THERAPY CERTIFICATION

FOR ATHLETIC TRAINERS & SPORTS PHYSICAL THERAPIST
NAME

First NameMiddle NameLast Name
PROFESSIONAL CREDENTIAL(s)
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
EMAIL (personal email recommended)
PHONE NUMBER

Area CodePhone Number
EMPLOYER
YEARS OF CLINICAL PRACTICE / EXPERIENCE
REFERRAL SOURCE

Other
IF REFERRED BY IAR FACULTY / STUDENT, PLEASE IDENTIFY THIS INDIVIDUAL
ENTER YOUR SMTC COURSE DATE & LOCATION
T-SHIRT SIZE
ADDITIONAL COMMENTS
PLEASE COMPLETE PAYMENT TO CONFIRM COURSE PARTICIPATION.

SMTC$875.00

Enter coupon

Total $0.00

Debit or Credit Card

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