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This form is used to register for continuing education (CE) courses sponsored by the Northwestern University Prosthetics-Orthotics Center (NUPOC). To learn about current course offerings including subjects, dates, and registration fees, please visit the NUPOC CE Website.

Payment for courses will be done via credit card. Once you submit this registration form, you will receive an email with a link to make your payment.

If you have questions about other forms of payment, please contact Elizabeth Rowe at e-schreiber2@northwestern.edu

Which continuing education course would you like to attend?

Month/Year of course offering

Registrant

First Name

Last Name

Email Address

Phone Number

Registrant professional credentials

Choose all that apply

Physical Therapist (PT)

Resident/Fellow Physician (MD/DO)

Physician Assistant (PA)

Occupational Therapist (OT)

Podiatrist (DPM)

Prosthetist and/or Orthotist (CP/CO/CPO)

Attending Physician (MD/DO)

Nurse/Nurse Practitioner (RN/APN)

Other

Employer / clinical affiliation

Organization name

Address - Line 1

Address - Line 2

City

State

ZIP Code

Special needs, notes, or requests:

Upon successful completion of the course, attendees will be provided a certificate. Enter the registrant's name as it should appear on the certificate of completion.

Example: Jane Doe, MD, FACS

This registration form will automatically be sent to the registrant identified above. To have a copy submitted to an additional person at the registrants clinical affiliation, please enter their email address in the prompt below.

Please sign below to confirm the registration and accept the policies associated with participating in this CE course.

Sign Here

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