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Registration Info

Registration Form

Reserve a Space

Reserve a Space

Fill out the reserve a space now form below. We will reserve you a space while awaiting your offical registration information. Registration is contingent upon receipt of full tuition. Reserving a space does not guarantee registration. You must either mail, fax or phone course tuition payment to register.

Our courses have limited enrollment. We will maintain a chronological wait list when the course fills.

*Required Field

Reserve a Space Now Form
*Last Name:
*First Name:
*Phone 1:
Phone 2:
*Email (for confirmation):
Physical Therapy License #:
License State:
*I will register by: Mail
*Payment Method: Check
You must still register, this just reserves your space.