Advance Diagnosis and Nutrition in Practice

Symposium 2012 Registration

Chicago, IL  July 20-22, 2012

You can register by phone: 920-860-5432, by fax 920-682-6983 

                                        Or by mail:     Attn: Loretta Brandl

                                                            3713 Calumet Avenue 

                                                            Manitowoc, WI 54220

 

Please copy and paste into a word document to print.  Thank you

Fees are as follows:

 

CDID-ACA Symposium members rate             $455.00 x __________

(you must be a current CDID and ACA member to receive the discount)         

 

Non- members registration rate                     $495.00 x __________

 

Spouse, student, and office staff rate             $110.00 x __________

(includes Fri and Sat lunches) Please print name (s) 

_______________________________________________________________


You must be a CDID and ACA member to apply for member rates

 

CDID annual dues* (Due 07-01-2012)                 $120.00 x __________
(If you are a 2011-12 member, your membership expires 06/30/2012. Please renew your membership with your registration to be eligible for the member discount)

 

AACP- Optional                                               $150.00 x __________
(American Academy of Chiropractic Physicians)
(The CDID will forward these dues to the AACP)

 

ACA- American Chiropractic Association dues of $630.00 must be paid directly to the ACA (on or before your individual anniversary date.)   

 
Symposium 2012 cancellations after June 30,2012 are subject to a 50% cancellation fee.

Please make sure to print information CAREFULLY. The information listed below is what is listed on the website.

Name and Degree(s):______________________________________________________

Address:________________________________________________________________

City:__________________________________State:_________Zip:_________________

Phone: (_______)___________________Email:_________________________________

Website:_________________________________________________________________

 
Method of payment: Check (please make checks out to CDID)  Visa, MC, AMEX, & Dis

Credit card #:________________________________________Expires:______________

Three digit security code:____________Total amount enclosed/charge$______________

Signature:_____________________________________________Date:______________