Club Members Registration Form

Name
Address
City   State   Zip Code
Phone    Email

I am a member of:
Century Club    Presidents Club    Ambassadors Club   Club Member CA  

First Year Member   Student Member

Total Number of Attendees

Name(s) of Attendees:

Please indicate which seminar(s) you plan to attend:
Dr. Christophe Dean - Activator
Dr. Van Merkle - Science Based Nutrition
Dr. Fred Schofield - Latest Technologies
Attorney Richard Gaffin - Ethics & Boundaries - Friday, 4-6
Attorney Richard Gaffin - Ethics & Boundaries - Saturday, 9-11
G. Kent Mengelson - Lawsuit Protection
Plenary - Various Speakers
Dr. Jay Kennedy - Traction & Decompression
Dr. Patrick Gentempo - Philosophy
Dr. Jay Greenstein - Functional Rehab
Dr. Dick Versendaal - Contact Reflex Analysis
CAs - Brenda Fredericksen - CA's Role in the Healing Process
CAs - Phyllis Frase - Philosophy & the Front Desk

Please indicate if you plan to attend an Alumni Lunch:
Life;  Logan;  National;  Palmer;  Sherman