Pediatric Physical Therapy

Register as a New Member

Certification of Professional Status
Enter the information in the fields below and click "Register Me! " when finished. You may pick any member user ID and password you wish. You will need to use them to enter password protected bulletin boards and member services. *Remember* : The password and ID are case sensitive! When you use you password and ID, they must be the same capilization as what you enter below (ex. pedspt and Pedspt are not the same) * Marks required fields

First Name, Middle Name		*
Last Name, Suffix (e.g. Jr.)		* ,
Place of Business		*
Address 1		*
Address 2
City		*
State (2 letter)/Province		*
Zip/Postal Code		*
Country (please leave blank for USA)
Phone		*
Fax
Email (do not include spaces, enter entire address, e.g. my address@aol.com)		*
Member User ID (to log in)		* case sensitive
Password (to log in)		* case sensitive
Type Password again		* case sensitive
* Required Fields
Notifications Do not display phone number online Do not display email online Notify of new course listings (via email) Notify of new jobs postings (via email) Check all regions you wish to watch for new jobs: Midwest South Northwest Southwest Southeast Northeast Great Lakes		Areas of Interest (check as many as desired) Cerebral Palsy Spina Bifida Osteogensis Imperfecta Arthrogryposis Multiplex Congenita Oncology Cystic Fibrosis Muscle Disease Seating and Mobility School-based Early Intervention NICU

Please select your occupation from the list. If you are a student, you will be prompted to enter the name of the school you are attending. If you are a physician, you will be prompted to enter you specialty. These are required fields.
Occupation
Click "Register Me!" to submit your registration information. By clicking this button, you certify that all the information provided on the form is a true representation of your professional status. Privacy Policy