Attendance Verification Form Information Step 1 of 3 33% Attendee InformationWhich conference date are you registering for?*November 1-2, 2025November 8,2025March 7-8,2026Name* First Last Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Florida Chiropractic License Number*Please enter your license number in this format: CH12345. Please do not use leading zeroes.If you are not yet licensed, please enter: N/A Additional State Licenses -$50 fee per state licenseIf you would like a CE certificate for other states please provide state and license number. Please note there is an additional $50 fee per licenseCell Phone*Email*Email is our primary method of communication! You will receive your Registration Confirmation, CE Voucher, Schedule, and all information pertaining to the program via email. Please enter a valid email address and add the 'flchirocon.com' domain to your 'Safe Senders' list to ensure that you receive all pertinent information about your registration! Email Preferences*Check the boxes to indicate your email preferences. Add me to your email list. I would like to receive emails/special offers from this event's sponsors. Please ONLY send me conference information. Cancellation Policy*Cancellations within 72 hours of your registration, will be refunded less a $30 processing fee. Any cancellations after 72 hours will be issued a 50% refund of the registration fee. In order to process your cancellation, you must notify Florida Chiropractic Conferences (FCC) via email no later than seven (7) days prior to the event. Cancellations received within seven (7) days of the event will not be eligible for a refund. Transfers are subject to a $30 fee. Refunds / Transfers will not be available for registrants who forget / don't attend the event. Refunds or transfers will not be provided after the conference has occurred. Please note that refunds and transfers can take up to 48 hours to process. Yes, I agree. Please continue with my registration. No, I do not agree to these terms. I understand I will not be able to pre-register for this event. Synchronous Learning Policy*By registering for this event, I acknowledge that it is my responsibility to have an electronic device with audio visual capabilities and internet access. FCC bears no responsibility for your equipment malfunction or your internet carrier. Yes, I understand. Please continue with my registration. No, I do not agree to these terms. I understand I will not be able to pre-register for this event. Live Virtual Agreement* I understand that this conference will only be available via live virtual. CE Certificate InformationIf you are receiving CE hours, you MUST fill out the necessary information below for Parker University's "Attendee Verification Form".CE Hours For each CoursePlease enter the number of CE hours for each course you intend to attend. At the bottom of the page please enter the total CE hours.Saturday, November 1, 20258:00am-10:00am: Elevating Spine Care: Combining Spinal Decompression and High-Power Laser for Superior Outcomes*Category: General Instructor: Dr. Christopher M. Proulx, DC, PhD(Abd), CSCS 01210:00am-12:00pm: The New 2024 CPT & DIAGNOSIS Codes and their Relative Values*Category: Recordkeeping/ Coding/Doc Instructor: Samuel Collins, DC 0121:00 - 3:00 pm: Physical Medicine Rehabilitation Guidelines and Boundaries*Category: Recordkeeping/Coding/Doc Instructor: Samuel Collins, DC 0123:00 - 5:00 pm: Avoiding Common Errors – Know Your Electronic Footprint*Category: Medical Errors Instructor: Salvatore LaRusso, DC 0125:00pm-7:00pm: Understanding Ethics and Boundaries in a Chiropractic Office*Category: Ethics Instructor: Kevin Fogarty, DC, FICA (Hon.) 012Sunday, November 2, 20258:00am-10:00am: Laser Therapy- Lighting the Way To Augmented Chiropractic Care* Category: General Instructor: Jennifer Novak MS, CSCS*D, doctoral student, University of East London 01210:00 - 12:00 pm: Medicare Done Right: Bullet-Proofing Your Practice*Category: Recordkeeping/ Coding/Doc Instructor: Jeffrey Lewin, DC, CCSP 0121:00 - 3:00 pm: Active Care and Rehabilitation: An Outcomes-Based Approach to Patient Care*Category: Recordkeeping/Coding/Doc Instructor: Jeffrey Lewin, DC, CCSP 0123:00 - 5:00 pm Understanding Florida Laws & Rules and how they affect the way you Practice*Category: FL Law Instructor: Kevin Fogarty, DC, FICA (Hon.) 0125:00 - 7:00 pm: Are you prepared? How to plan for Workplace Emergencies.*Category: Risk Instructor: Andrew DeSaro, DC 012TOTAL CE HOURSTOTAL CE HOURS*Please add up all of of your CE hours.1234567891011121314151617181920Attestation of CEU's*I do hereby attest that the information I provided is true, accurate and complete and I attest to the fact that I will attend and complete all the CEU’s I have signed up for. I understand that my hours will be verified with my online log in. Yes, I understand. Please continue with my registration. No, I do not agree to these terms. I understand I will not be able to pre-register for this event. PaymentPlease select your registration choice* Full Registration (up to 20 hours) Partial Registration (up to 10 hours) CCPA(up to 12 hours) Additional State License Bundle & Save Full 20 hrs. + 4 hrs. Acupuncture Promo CodeIf you have a promotional code, please enter it here. Total $0.00 Credit CardCard Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. Δ