Physical and Occupational Therapists' Guide to Myositis Event Registration Form

Welcome! This year we will be at Gold Eagle Distributing, 7051 Wireless Ct, Sarasota, FL 34240 (east of I-75, south of University Parkway, just off Lakewood Ranch Blvd). The symposium with free dinner takes place on Wednesday, May 15, 2024 from 5-8 PM ET. Do note that this event is not for patients.

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* 1. Name

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* 2. Email

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* 3. Phone number

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* 4. Clinic, Office, or Organization

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* 5. Office Address (so that we may match you with new clients)

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* 6. Which title describes you?

PT - Physical Therapist

OT - Occupational Therapist

PTA - Physical Therapist Assistant

OTA - Occupational Therapist Assistant

Student

Other (please specify)

Physical and Occupational Therapists' Guide to Myositis Event Registration Form

Question Title

* 1. Name

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* 2. Email

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* 3. Phone number

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* 4. Clinic, Office, or Organization

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* 5. Office Address (so that we may match you with new clients)

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* 6. Which title describes you?

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* 7. What is your license number? Upon completion, two CEUs will be submitted to Florida PT and OT boards. Type N/A if does not apply.

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* 8. Do you have dietary restrictions? (if yes, please specify)