Registration Registration Form Select an Event I want to attend the October 14th -15th, 2023 Chiropractic Seminar - "Fully Equipped. Presented by Claudia Anrig, DC and Larry Palevsky, MD. DC meets Wellness MD for healthier families and extraordinary results." in Dallas, Texas I want to report my interest/secure my spot for "The Adjustors Art" Seminar at Life University (Spring 2024, date: pending, We won't charge you any fee.) Select One D.C. Student Associate DC or DC spouse Non-DC Spouse Chiropractic Assistant Other Other Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican 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 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same as above Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican 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 Prices - Fully Equipped Seminar DC: Registration for this 12-hour event will be $545 With CE it will be $580 Students - $290 Associates & DC Spouses - $290 Non-DC Spouses - $145 Other professionals: $395 CE fee: $50 per stateLicense State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense Number: * There is a $50 processing fee for continuing education credits. Please note that providing us with your license number does not guarantee continuing education credit for the event. For a list of CE approved states or provinces please visit our FAQ page or call our office at (559) 291-7800 with any questions.Add another State and License number Yes Check this box if you do NOT need/want continuing education credit, otherwise, leave this box unchecked. Warning, by checking this box you are indicating that you do not need continuing education credit for this event and will not be charged the $50 processing fee.License State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense Number: Add another State and License number Yes License State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense Number: Add another State and License number Yes License State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense Number: Cancellation Policy Cancellations received in our office up to 14 days prior to the seminar date are subject to a 20% service charge. Cancellations after the 14-day deadline, and up to 5 PM on the day prior are subject to a 40% service charge. “No shows” or cancellations the day of the seminar are liable for the entire fee. Any cancellation fees charged can be applied as a credit toward registration fees for a future event. All cancellations must be in writing or via email. If the Adjustors cancels for any reason, our liability is limited to the return of the registration fee only. The Adjustors will not reimburse any registrant for any travel or hotel cancellation fees or penalties.* I accept the cancellation policy. * Seminar Policies We carefully adhere to CE requirements and, as such, signing in and out of each session on time will be necessary for full CE credit. Regarding children in attendance, although the seminar revolves around this very special segment of the population, to preserve the quality of this program, we request that children remain outside the event room during the entire presentation. No video or audio recording of the instructors is allowed without their permission. * I accept the seminar policies. * Liability Policy By registering for this event, I acknowledge the contagious nature of COVID-19 and other illnesses and further acknowledge that the Adjustors and its administration, the hotel, vendors and/or instructors cannot guarantee that I will not contract an illness during this event and I affirm that I understand the risks. * I accept the liability policy. * Social-Distancing Policy By registering for this event, I acknowledge that this seminar includes lectures combined with a hands-on experience. It is possible that the instructor and/or other attendees may not be able to maintain a social-distance. While attendees are not required to participate in the hands-on portion to receive CE credits; it should be noted that the seminar and instructors will not be responsible for maintaining social-distancing.* I accept the social-distancing policy. * Hotel Information - Fully Equipped Seminar Book your hotel room for a discounted rate: https://www.marriott.com/event-reservations/reservation-link.mi?id=1690394108990&key=GRP&app=resvlink Our event is being held at Sheraton DFW Airport Hotel 4440 W John Carpenter Fwy Irving, TX 75063 - Marriott.com/DFWAH . They are offering a special rate for accommodations at this same hotel of just $129 per night plus applicable fees and taxes for a single or double occupancy. Call (972) 929-8400 to reserve your rooms and be sure to mention Dr. Claudia Anrig’s Seminar to receive the special rate. Room reservations must be made before, October 1st, 2023. to receive the discounted rate. Self-parking is available in the Rosemont Convention Center for $15 with no in and out privileges or $29 per day with in and out privileges. Valet parking is available at the hotel for $25 a day or $35 for overnight parking. The hotel offers a complimentary shuttle to and from the airport. How did you hear about the Seminar? (Check as many as apply)* Facebook Postcard College Generations Member Discount Code: Include any comments here pleaseTo register for Seminar by phone or if you have any questions call (559) 291-7800.During Summer Time the processing of the registration might take up to 7 days and the Registration Confirmation will not be sent out immediately. Still, directly after the submission of the registration, your spot at the seminar is guaranteed. CommentsThis field is for validation purposes and should be left unchanged.
