SPORTS MANUAL THERAPY CERTIFICATION (SMTC)

SPORTS MANUAL THERAPY CERTIFICATION

FOR ATHLETIC TRAINERS & SPORTS PHYSICAL THERAPIST
NAME*

First NameMiddle NameLast Name
ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
PREFERRED EMAIL*
PHONE NUMBER*

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

IAR FACULTY / STUDENTIAR WEBSITEAPTA / NATAE-NEWSLETTERSOCIAL MEDIA
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. PLEASE USE THE YELLOW PAYPAL BUTTON DURINNG CHECKOUT.

Payment

SMTC$875.00

Enter coupon

Total $0.00

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