Loyalty Program Registration Step 1 of 3 33% Attendee InformationName* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Florida Chiropractic License Number*Please enter your licences number in this format: CH99999Please do not use leading zeroes.If you are not yet licensed, please enter: N/A Additional State License NumbersPlease enter any other states your are licensed in and your license number.Cell 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 Acknowledgement* I understand that due to the current changes this conference will only be available via live virtual. Save and Continue Registering Later! CE Certificate InformationIf you are receiving CE hours, you MUST fill out the necessary information below for Parker University's "Attendee Verification Form".Chiropractic College Graduation Year 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, August 14, 20218:00am-10:00am: Acupuncture Technique for the Certified Chiropractor (Acupuncture Technique)*Dr. Richard Merritt01210:00am-12:00pm Acupuncture Safety, Risks and Conditions (Acupuncture Risk)*Dr. Richard Merritt012TOTAL CE HOURSTOTAL CE HOURS*Please add up all of of your CE hours.1234Attestation 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. Save and Continue Registering Later! PaymentPlease select your registration choice* Acupuncture Hours Promo CodeIf you have a promotional code, please enter it here. Total $0.00 Credit CardPlease check if you have activated a Stripe feed for your form.PhoneThis field is for validation purposes and should be left unchanged. Save and Continue Registering Later!