Wound Care Resources, Inc
180 Cherry Street,
Williams Bay, WI 53191-9704
Phone: 262-245-6712
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Email: woundseminars@sbcglobal.net

 


Please print the form below for seminar registration and mail to us regardless of your payment type.

To pay for
CURRENT CONCEPTS IN WOUND
HEALING
use the payment button below. (I understand that my payment is non-refundable per the registration form guidelines below)

To pay for
ADVANCED
WOUND HEALING
use the payment button below. (I understand that my payment is non-refundable per the registration form guidelines below)

 
REGISTRATION FORM:
Please register me for: CURRENT CONCEPTS IN WOUND HEALING™ for: (Fill in City/State & dates) ______________________________________.
Please register me for: ADVANCED WOUND HEALING™ for: (Fill in City/State & dates) ______________________________________.

CIRCLE ONLY ONE PAYMENT TYPE
(Payment by www.paypal.com is preferred) Using your credit card at Pay Pal is easy!

1.) I paid by www.paypal.com Pay to: woundseminars@sbcglobal.net
2.) A check is enclosed: Make it payable for either $399 Early Bird Special (30 days prior to program) or $449 (FOR EACH SEMINAR) to and mail to:

Wound Care Resources, Inc.
180 Cherry Street
Williams Bay, WI 53191-9704

I understand and agree that the seminar cost is not refundable for any reason except that a full refund of course cost will occur if Wound Care Resources, Inc.(WCR) cancels a seminar for any reason under its control. Liability for refund is limited to course cost and not for any other expense that may be incurred by the registrant. WCR will not be held liable for any refund should a course be interrupted by an act of God or an act of war or for circumstances beyond its control. The materials presented in CURRENT CONCEPTS IN WOUND HEALING™ and ADVANCED WOUND HEALING™ by WCR and Jeffrey A. Feedar, PT, CWS®, (Speaker) are presented for information purposes only and WCR and the Speaker accepts no responsibility or liability for a course participant to implement this information in any specific patient plan of care or any other setting. Each course participant agrees they are wholly responsible to determine the appropriateness of materials presented, for practicing under the laws in the state and/or country in which they practice, and for practicing within the scope of their license. Each course participant will be required to sign a release statement on day one of the seminar prior to the seminar beginning. No registrations will be accepted without this form filled out (* = required field) by the registrant and registrant's signature and agreement to these conditions.

Your signature on this registration form states that you have read, understood, and agree to these conditions governing WCR seminars and information presented by the Speaker.

*Name (print) ____________________________________________________________________
*Credentials (PT, PTA, RN, LPN, MD, OT, CWS®, DO, DPM, NHA, ATC, etc.)______________
* License number(s) and State(s) (For CEU CERT.)______________________________________
________________________________________________________________________________
*Home Address (DO NOT use your work address as we register people not facilities.)
________________________________________________________________________________
*City/Sate/Zip____________________________________________________________________
*Phone (home) (_______________)___________________________________________________
*(Very helpful!) Email______________________________________________________________

PLEASE CHECK YOUR EMAIL FOR CONFIRMATION LETTER - This is where we will send your confirmation letter if you supply your email address! Thank you!

*Signature_____________________________________________ *Date _____________________