GlSeminars - Registration

	Registration for a Great Lakes Seminars course is secured by Geotrust

First Name

Last Name

Street Address

Apartment

City

State

Zip Code

Contact Phone Number

(Example xxx-xxx-xxxx)

Fax Number

(Example xxx-xxx-xxxx)

E-mail Address

Registration Fee

$495

Discount

Multiple Registrant	Multiple Course
Series Discount
Please see the "Discount Information" section of this form for the qualifications for each discount and the information that you are required to provide. Please note if you are eligible for more than one discount, we will take the greater of the discounts and apply it to your course fee. One discount given per course

Course Type

Course Location

Credit Card Type

Credit Card Number

Credit Card Expiration Date

Credit Card Holder Name

Diciplines

PT	OTA
PTA	ATC
OT	Other
Please select the diciplines that apply to you. A minimum of one selection/value is required before submission.

Discount Information

Multiple Registrant - You need to have at least 3 registrants from your facility, supply their names, and they must actually register. Please list the names in the text box below. All payments are due in advance of the seminar and discounts will be given once all names given have actually registered for the course. There is a $25 discount per registrant for three or four registrants and a $50 discount per registrant for five or more registrants.

Multiple Course - If you sign up for two or more courses on the same day you will receive $50 off the additional registrations (example: first course = $495, additional courses = $445). Great Lakes Seminars will try to monitor this but please put the courses that you are signing up for in the text box below. You can also receive this discount by registering for a course within 2 weeks of attending a Great Lakes Seminars course.

Series Discount - We offer discounts for both our Spinal Series and Extremity Series of courses. The Spinal Series consists of the Cervical-Thoracic, Lumbar Complex and Sacroiliac courses. The Extremity Series consists of the Shoulder, Knee and Foot and Ankle courses. The Series discount is based off a total price of $1150 for all three courses in a series. You do not need to register for all three courses at once. When you are registering for your final course in a series, please let us know the other courses you have previously taken. We will look at how much you paid for the courses and charge you the correct amount to total $1150. Series discounts must be utilized at the time you register for the final course of a series. Courses taken as private courses at a facility do not count towards series discounts.

Other Discount - If you are utilizing a discount that is not mentioned above, please include the details below.

Discount Details

Cancellation Policy

Cancellation Policy - Great Lakes Seminars reserves the right to cancel the course up to two weeks prior to the first day of the course. Great Lakes Seminars will not be responsible for any charges incurred by the registrant due to the cancellation of the course, other than the cost of the course.

There is a non-refundable cancellation fee of $50 if you cancel more than two weeks out from the first day of the course or you can switch your registration to a different course. There will be absolutely no refunds given after the two-week mark before a seminar. If you must cancel your registration within two weeks of a course there is a non-refundable $50 cancellation fee and you will be allowed to come to the same course that you missed (any location). Registrants have until 1 weeks after a course to notify us that they were unable to attend a course.

Training Materials - All training materials will be provided at the course by Great Lakes Seminars.

Traditional Mail - You may also print out this registration form and mail it (with either a check or your credit card information) to: Great Lakes Seminars, 5048 Summer Dr., Sylvania, OH 43560.

Confirmation Letters - Upon receiving your registration and payment, Great Lakes Seminars will mail you a confirmation letter which will supply all of the necessary information about the seminar. If you are applying within two weeks of the seminar you want to go to, please provide a fax number or email address so we can fax or email your confirmation letter.