Please Check here if you do not wish to have your information shared with exhibitors.
*Corporate Member Rate Fee for each registrant of 3 or more active APTA member
registrants from the same employer.
**Other Professional Rate: Registrants not eligible for APTA membership. Additional
discounts may apply.
Guest Rate: Guest must register with a paid conference attendee. APTA members
and those eligible for APTA membership cannot register as guests. Please note that
children under 18 are not permitted in the exhibit hall.
Check here and let us know if you have any special needs at this meeting.
APTA will contact you to assist. __________________________________
Please Check one:
__ PT __PTA __ Student PT __ Student PTA
One Registrant Per Form (print or Type)
Registration Fees: Registration fee does not include special events
Special Events (Optional)
First Name, Middle Initial, Last Name APTA Member No. Nickname for Badge
Daytime Phone Number E-Mail Address
Address City/State/Zip
Company or Educational Institute
Guest Name (if registering, First and Last Name Required)
Emergency Contact (Name, Phone, Email)
CORPORATE MEMBERS ONLY
Facility Name Contact Name
Cancellations and Refunds
This cancellation policy applies to all elements of the conference. There is no separate
fee for cancelling participation in preconference courses.
Cancellation requests for conference registrations received by January 31, 2022 will
receive a full refund minus a $25 administration fee.
There will be no refunds for cancellations received after January 31, 2022. Cancellation
requests must be submitted in writing to the APTA Registration
Center, aptaCSM@mcievents.com .
Preconference Courses and Fees (Optional) (see page 2 of form for course codes)
Celebration of Diversity Event – Thursday, February 3
Fee: $60 is non-transferable and non-refundable. # of Tickets ____________
Party on the Riverwalk with PTPAC – Friday, February 4
Fee: $100 is non-transferable and non-refundable. # of Tickets ___________
Method of Payment: Mail this form OR register online at www.apta.org/CSM. FAX: 972-349-7715 Phone: 800-809-9565
Section Member Pricing Non-Section Member Pricing
Course Code ___________ $__________ Low (A) High (B) Low (A) High (B)
1 Day Course $285 $335 1 Day Course $385 $435
Course Code ___________ $__________ 2 Day Course $430 $505 2 Day Course $530 $605
Full payment must accompany your registration form with credit card information, check, or purchase orders made payable to APTA to: American Physical Therapy
Association P.O. Box 716305 Philadelphia, PA 19171-6305. APTA reserves the right to charge the correct amount. Inactive members will be charged the nonmember fee.
VISA MASTERCARD AMERICAN EXPRESS DISCOVER
CARD NUMBER: _____________________________________________________ EXP DATE: ________/________
NAME OF CARD HOLDER:______________________________________________CVV Code: ________________
BILLING ADDRESS:______________________________________________________________________________
SIGNATURE____________________________________________________________________________________
Payment Terms and Conditions:
By signing you agree to the terms of the registration cancel polices for APTA CSM 2022. You also agree to the code of conduct for CSM 2022. View the terms and
conditions of APTA’s websites and forums. APTA is committed to providing a safe, productive, and welcoming environment for all meeting participants and staff. This online platform is governed by the terms
and conditions of APTA’s websites and forums. APTA reserves the right to take any
action deemed necessary and appropriate, including immediate removal from the meeting without warning or refund, in
response to any incident of unacceptable behavior, and APTA reserves the right to prohibit attendance at any future meeting, virtually or in person.
Total:
Conference Registration: $________
Preconference Courses: $ _______
Special Event: $________
My Total: $____________
Please Check One
Personal Card? Corporate Card?
Page Two Attendee Name: _______________________________________
Preconference Courses: Enter the code for the preconference course you wish to attend on the first page of this form.
Note: To receive Section Member pricing for a preconference course, you must be a member of the sponsoring section for
that course. If you are not a member of the sponsoring section, you will receive the Non-Section Member pricing.
Code
Pre-Conference Session Title
Date
Section Member
Non-Section
Member
Advance Until
12/16/21
Advance Until
12/16/21
HH-10987
A Breath of Fresh Air: Interventions for Dyspnea
W
$285
$385
ED-11123
Active Learning Strategies To Effectively Integrate Pain Competencies in Entry-
Level Professional and Postprofessional Training
W
$285
$385
HH-10556
Advanced Competency in Home Health Certification for the PT and PTA
T-W
$505
$605
OR-10427
At the End of Your Rope: Rehab Solutions for Climbers and Aerialists
T
$285
$385
FD-10363
At the Tip of the Spear: Sharpening Your Skill Set as a Direct Access PT
T
$285
$385
SP-11421
Between the Seams: Comprehensive Rehabilitation for the Throwing Athlete
W
$285
$385
PP-10829
Beyond Patient Discharge: A Crash Course on Bridging the Gap Between
Physical Therapy and Medical Fitness
W
$285
$385
SP-11420
Building a Better Runner: Factors to Consider, Evaluation, Intervention, and
Prevention
W
$285
$385
GR-11604
Change the Way You Think About Physical Therapy: Activities for Developing
Alternative Models to Care
T
$285
$385
CP-11448
Clinical Practice in Cardiopulmonary Physical Therapy: Are You Practicing Best
Practice?
W
$285
$385
NE-10390
Concussion Subtypes- Is It Relevant for Physical Therapists?
W
$285
$385
ED-10421
Creating Engaging, Inclusive, and Active Learning Experiences: A Day Without
PowerPoint
W
$285
$385
NE-11032
Engaging Students in the Evidence: Active Learning Strategies for Physical
Therapist Education
W
$285
$385
ED-11443
Education Research: How to Begin Your Journey (Mini-GAMER)
W
$285
$385
OR-10621
Innovative Strategies in Residency Fellowship Implementation: Creating
Adaptability While Maintaining Accreditation in an Evolving Landscape
W
$285
$385
RE-10734
Integrated Mixed Methods in Physical Therapy Research
W
$285
$385
GR-10993
Integrating Lifestyle Medicine Into Physical Therapy for the Aging Adult
W
$285
$385
PP-10718
Kick-Starting Your Private Practice: A Day of Interactive Consulting
W
$285
$385
HP-10477
LAMP Leadership 101: Personal Leadership Development - the Catalyst for
Leading Within
T-W
$505
$605
HP-10554
LAMP Leadership 201: Advanced Leadership Development - the Catalyst for
Leading Others
T-W
$505
$605
HP-10685
LAMP: Advanced Management Concepts
T-W
$505
$605
PH-11684
Let's Talk About Sex
T
$285
$385
HP-11339
LGBTQIA+ Brave Space Training: Critical Conversations and Action in Physical
Therapy
W
$335
$435
OR-11024
Modern Pain Curriculum for DPT Students: Application of the Pain Education
Manual for DPT Educators
T
$285
$385
PH-11921
Movement and Pregnancy: What All PT’s Should Know!
W
$285
$385
OR-10657
Musculoskeletal Ultrasonography of Upper Extremity with Special Focus in Sport
and Performing Arts.
W
$285
$385
PH-11685
Online Marketing for Pelvic Floor Physical Therapy
T
$285
$385
Page Three Attendee Name: _______________________________________
Preconference Courses: Enter the code for the preconference course you wish to attend on the first page of this form.
Note: To receive Section Member pricing for a preconference course, you must be a member of the sponsoring section for
that course. If you are not a member of the sponsoring section, you will receive the Non-Section Member pricing.
Code
Pre-Conference Session Title
Date
Section Member
Non-Section
Member
Advance Until
12/16/21
Advance Until
12/16/21
AQ-10624
Pediatric Aquatics for Infant Through Adolescent Populations
W
$335
$435
OR-11264
Post-Concussion Evaluation and Treatment: Implementing the Clinical Practice
Guidelines
W
$285
$385
FD-10585
Practical Applications To Integrate Neuroscience (P.A.I.N) 2.0: Empowering
Patients With Persistent Pain
W
$285
$385
AC-10960
Prosthetics for Physical Therapists: Integrating Lower Limb Prosthetic
Componentry Into Practice
W
$285
$385
FD-10706
Returning to Running: From the Clinic to the Track
W
$285
$385
GR-10415
Tai Chi Fundamentals Adapted Program Basic Moves Training (Course 1)
T-W
$430
$530
CE-10652
These Are a Few of Our Favorite Things: Tools to Maximize Function and Wound
Management
W
$335
$435
FD-10514
Utilizing Diagnostic Imaging in Direct Access Physical Therapy: Where To Start and
Where To Go
T
$285
$385
PD-10791
Welcome to the Resistance! Supercool PNF to Improve Pediatric Trunk, Foot, and
Ankle Function
W
$335
$435
ON-10686
Yoga Based Physical Therapy for Survivors of Cancer: The Journey from Recovery
to Wellness
T
$285
$385
