Regional Course Host Request Form Survey

Are you interested in hosting an upcoming Regional Course? Tell us more about you and we'll get back to you as soon as possible.

What are the benefits to hosting?

- Recognition as a co-sponsor with APTA Geriatrics during the course

- Complimentary registrations (determined by course options/registration numbers)

- Advancing the practice of geriatric physical therapy in your area

Find out more about the following courses:

C ertified Exercise Expert for Aging Adults (3-course series)

Advanced Credentialed Exercise Expert for Aging Adults (2-day course)

Advances in Exercise for the Older Adult (A PTA Focus course)

Balance and Falls Prevention in Community-Dwelling Older Adults

Please complete the following form:

1.The name of your site

2.Address of your site

3.Contact person's name

4.Contact person's phone number

5.Contact person's email address(Required.)

6.Please re-enter email address(Required.)

7.Which course are you interested in hosting? (check all that apply)

Certified Exercise Expert for Aging Adults (3-course series)

Advanced Credentialed Exercise Expert for Aging Adults (2-day course)

Advances in Exercise for the Older Adult:A PTA Focus Course (2-day course)

8.Please suggest potential dates/months preferred to host (We do not schedule courses from Thanksgiving through CSM in February, nor the weekend of the host site's state chapter conference.)

9.Which airport is closest to the facility?

10.What hotels are closest to the facility?

11.Does the facility offer discounts for these hotels?

Current Progress,

0 of 11 answered