Wound Care Associates
(A Division of Wound Care Resources, Inc.)
180 Cherry Street, Williams Bay, WI 53191-9704
Phone: 262-245-6812 ---
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) |
| 2008 REGISTRATION FORM: Please register me for: CIRCLE ONLY ONE PAYMENT TYPE A check is enclosed or I paid by PAY PAL for CURRENT CONCEPTS IN WOUND HEALING™
for $495.00, or for If you are sending a check … make it payable to and mail to: Wound Care Associates (A Division
of Wound Care Resources, Inc.) ADVANCED WOUND HEALING™ Prerequisite: I attended CURRENT CONCEPTS IN WOUND HEALING™ during 2003-2008 in: (city/state)____________________________ on (dates ) ___/___/___ & ___/___/___. I understand and agree that the course cost is not refundable for any reason. I understand and agree that Wound Care Associates (A Division of Wound Care Resources, Inc.) (WCA) 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. A full refund of course cost will occur if WCA 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. I understand and agree that the materials presented in CURRENT CONCEPTS IN WOUND HEALING™ and ADVANCED WOUND HEALING™ by WCA and Jeffrey A. Feedar, PT, CWS®, (Speaker) are presented for information purposes only and WCA 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 I understand and agree that I am wholly responsible to determine the appropriateness of materials presented, for practicing under the laws in the state and/or country in which I practice, and for practicing within the scope of my license. I understand and agree that I 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 completely filled out by the registrant and registrant's signature and agreement to these conditions. (All * fields of information are mandatory) Your signature on this registration form states that you have read, understood, and agree to these conditions governing WCA seminars and information presented by the Speaker. *Name (print) ____________________________________________________________________ *Credentials (PT, PTA, RN, LPN, MD, OT, CWS®, DO, DPM, NHA, ATC, etc.)_______________ *State Licensed in & License #___________________ Additional State Licensed in & # _________ *Home Address (DO NOT use your work
address as we register people not facilities.) *City/Sate/Zip___________________________________________________________________ *Phone (home) (_______________)__________________________________________________ *Email (home or work) _______________________________________________________________ *Signature________________________________________
Date ________________________ |