THE WOUND CERTIFICATION PREP COURSE

 

 To register please complete the information below, print, and mail to P.O. Box 1436, Wimberley, Texas  78676

or FAX to 512-722-3249.  NOTE:  Fax line is secure in a private office.

                                               

 

 

* Required

The Wound Certification Prep Course (WCPC)
  IDENTIFY WHICH COURSE YOU ARE ATTENDING
Date and
Location*

March 16-18, 2012 - Omni Park Hotel - Dallas, Texas

FEES

Early Bird Registration: $450.00 (14 or more days prior to the course)

Regular Registration: $475.00 (4-13 days prior to the course)

On-Site Registration: $495.00 (3 or less days prior to the course)
First Name*
Last Name*

Credentials(MD,RN,PT)*

 
Home or billing address for credit card processing*

 
City*
State*
Zip*
Hospital / Practice
Address
City
State
Zip
Daytime Phone*
E-mail Address*

 

                        Your confirmation letter will be E-mailed.

 

 Payment Method (please choose one):
Bill my Credit Card for the amount of $
Card Type
Name on Card
Card Number
 Exp. Date

Will mail a personal check or money order to:

         PARKS Institute, and mail to:  P.O. Box 1436, Wimberley, Texas  78676

Will call office with credit card information - Phone (800) 722-0080

If your registration fee is to be billed to your organization or is being paid by a third party,

         please use the space below to provide us with the details necessary to follow up with the

         paying party. 

        Please make checks payable to: PARKS Institute