First Adjustment Registration Registration Form FIRST ADJUSTMENT REGISTRATION Select an Event:* I want to attend the First Adjustment Seminar on October 19-20,2024 in Nashville, TN I want to attend the First Adjustment Seminar on October 26-27,2024 in Chicago, IL Select your title:* D.C. Student Chiropractic Assistant Name* First Last Preferred 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 Email* Office Phone*Cell Phone*Credit Card InformationWe accept VISA, MasterCard, American Express and DiscoverCredit Card #* Security Code* Expiration Date* Check if Credit Card Billing Address is 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 Registration Fees: For Doctor Saturday & Sunday: $525 Saturday Only: $345 License State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense Number: Practice Address * 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. If you require CE for this event, please provide your practice address, which is now required by PACE.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.There is a $50 processing fee for each state submitted for continuing education. 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 There is a $50 processing fee for each state submitted for continuing education. 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 There is a $50 processing fee for each state submitted for continuing education. License State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense Number: Chiropractic AssistantsLimited to two per Doctor: $99 for a Single Assistant OR $179 for Two Assistants Registration Fees: For Student Saturday & Sunday: $284 Family Wellness Practice Consultation Yes, I am interested in a complimentary 20-minute consultation. Dr. Claudia Anrig has been an international speaker and educator as well as a successful Family Wellness Practitioner for over 35 years. With this experience, she has offered her wisdom to hundreds of doctors over the past 16 years in her Generations program. As an attendee of First Adjustment, she would like to offer you a complimentary 20-minute consultation to discuss your dream Family Practice. If you are interested in taking advantage of this opportunity, please indicate by checking the box above and you will be contacted by one of our Generations support staff members.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 5:00 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 First Adjustment cancels for any reason, our liability is limited to the return of the registration fee only. First Adjustment 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 Dr. Anrig is allowed, however, photographing attendees during the technique session on Sunday is allowed and encouraged for review. * 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 First Adjustment and its administration, the hotel, vendors and instructor 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 instructor will not be responsible for maintaining social-distancing.* I accept the social-distancing policy. * Hotel Information Our October 26-27th event is being held at the DoubleTree by Hilton Hotel Chicago O'Hare Airport-Rosemont, located at 5460 North River Road, Rosemont, IL 60018. They are offering a special accommodations rate of $149 per night (plus applicable fees and taxes). Complimentary round-trip transportation to and from the Chicago O'Hare International Airport is included, and well as complimentary guest-room Wifi access. You can use our special booking link by Sept. 26 to secure this deal, or call +1 (847) 292-9100 directly when booking your room, just be sure to mention First Adjustment when making your reservation! Our October 19-20th event will be held at the DoubleTree Suites by Hilton Nashville Airport, located at 2424 Atrium Way, Nashville, TN 37214. They are offering a rate of $199 per night (plus applicable fees and taxes), with a discounted parking rate of $10 per day ($16 for overnight parking). You can reserve a room with this special rate by calling (615) 889-8889 and mentioning First Adjustment by September 18th, 2024. Please note that there is a $25 surcharge listed above with our registration fees; this charge is due to the hotel industry inflation hidden charges; for example, they are implementing a $1M insurance policy for all events, regardless of seminar size. These fees are unrelated to the offerings or services of Dr. Claudia Anrig or the First Adjustment Seminar, but it does allow for our own registration fees to stay fixed as opposed to increasing our own fees. How did you hear about our First Adjustment Seminar? (Check as many as apply)* Facebook Postcard College Generations Member Include any comments here pleaseTo register for the First Adjustment event by phone or if you have any questions call (559) 291-7800.EmailThis field is for validation purposes and should be left unchanged.
