CE Conference – Feb 2020 – Registration Page Step 1 of 3 33% Attendee InformationName* First Last 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/ACell 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 before 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 to attend the event. Please note that refunds and transfers can take up to 24 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. Save and Continue Registering Later! How many CE hours are you registering for?*Full Registration (up to 20 hours)Partial Registration (up to 10 hours)CCPA Registration (up to 12 hours)No CE Hours - RCA/CA/Staff RegistrationSubotal $0.00 Save and Continue Registering Later! Additional State License NumbersPlease enter any other states your are licensed in and your license number.Upload Your Picture!Skip the hassle of taking your ID out every time you enter and leave a class! Upload a clear, current headshot and we will print it directly on your name badge!Accepted file types: jpg, gif, png, pdf.CE Certificate InformationIf you are receiveing CE hours, you MUST fill out the necessary information below for Parker University's "Attendee Verification Form". 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Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged. Save and Continue Registering Later! This iframe contains the logic required to handle Ajax powered Gravity Forms.