* First Name

* Last Name

* E-Mail

* Primary Phone Number

* Credentials PT PTA Other

* Please Specify Credentials:

* Street Address

* City

* State

* Zip Code

* Are you a UNMC Physical Therapy Alumni? Yes No

* Year of Graduation from UNMC

* Do you work at a UNMC DPT Clinical Site? Yes No

* Are you a UNMC DPT Student Class of 2026 or Class of 2027? Yes No

* Do you have any dietary restrictions? Yes No

* Please Specify Restrictions

Payments are to be made by credit card on the next page.

Early Bird Course Fee: $895.00 ($750.00 for UNMC DPT Students, Alumni and CI at UNMC Affiliated Sites)
Course Fee after January 4, 2026: $950.00 ($800.00 for UNMC DPT Students, Alumni and CI at UNMC Affiliated Sites)

Cancellation/Refund Policy:

• 100% if cancelled 2 weeks in advance (by January 2, 2026)
• 50% if cancelled up until 2 days prior to course
• No refund if cancelled the day before the course

 * I have read and understand the Cancellation/Refund Policy.

Have questions about the event? Please contact ptconed@unmc.edu.