Please complete the application form below. Application Deadline April 1.  Applicants will be notified by April 15 if their application has been accepted. Applicants accepted to participate in this retreat will be required to complete a separate registration and will be allowed to submit an abstract to present at a poster session. The deadline for Registration is May 15. Instructions will be sent along with the acceptance notification.

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* 1. First Name

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* 2. Last Name and Credentials

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* 3. Address Line 1

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* 4. Address Line 2

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* 5. Address Line 3

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* 6. City

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* 7. State

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* 8. Zip Code

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* 9. Country

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* 10. E-mail Address

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* 11. Contact Phone Number

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* 12. Are you a physical therapist?

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* 13. If you are not a PT, please tell us your role:

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* 14. Please indicate your membership status

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* 15. Please indicate your status:
Students or post-doc should have their advisor send an e-mail to info@ptresearch.org verifying student status.

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* 16. Please indicate your primary type of employment:

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* 17. Tell us why you want to
participate in this retreat.

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* 18. Please upload an abbreviated Curriculum Vitae or
Biosketch in PDF Format (no more than 4 pages).

PDF file types only.
Choose File
No file chosen

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* 19. Do you plan to submit an abstract for a poster session?

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* 20. If you plan to submit an abstract for a poster, under which of the following topics would your abstract fall under?

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* 21. Housing: The Wiley Conference Center offers single and double occupancy rooms. Double occupancy rooms contain a King or Queen sized bed, and a roll-away bed as the 2nd bed.  Participants may request a single or double room and we will make every effort to accommodate the request.  As with previous SOR retreats, it may be necessary to assign participants, who do not know each other, to share a double room. 

If you are invited to attend the retreat please choose the following as it relates to housing (these options should be radio buttons from which applicants select only one):

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* 22. If you would like to share a room, please indicate the persons name 

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* 23. The SOR retreats are well known for the rich and fruitful discussion among speakers and paid participants. The success of the retreat depends on the full participation of all registrants so we regret that we cannot offer reduced registration for people who are unable to attend the entire duration of the retreat. If you are invited to register for the retreat, will you attend the entire duration of the retreat?

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* 24. Do you have any dietary restrictions?  If so, please specify

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* 25. If there is anything else you would like us to consider, please use this space.  

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