Fall Virtual Symposium Registration Virtual Symposium Registration 1Personal Information2Payment Information Personal InformationAARC NumberName* First Last Credentials* CRT RRT NPS ACCS SDS RPFT CPFT RPSGT MD DO RN Student Other Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Employment InformationFacility / School Job FunctionDirector / ManagerEducation CoordinatorProgram DirectorDirector Clinical EducationFacultySupervisor/LeadStaff TherapistSenior TherapistSales / MarketingStudentVSRC Board MemberJob settingHospitalSubacute / long term careCollege / universityHome CareSleep labPhysician officeIndustryPFT labOtherVSRC Board Position President President-Elect Past President Vice President Secretary Treasurer Delegate Blue Ridge District Director Central District Director Tidewater District Director Northern District Director Western District Director HiddenDo you require any special accommodations or dietary restrictions?* No Yes HiddenSpecial AccommodationsPlease identify special accommodations. RegistrationRegistration*Select choiceAARC Member 5 daysNon-AARC Member 5 daysStudent 5 daysAARC Member 1 dayNonAARC Member 1 dayStudent 1 dayIf only registering for 1 day, please specify what day. Discount Code Board member, event staff or speakers may enter their discount code.Total $0.00 Payment methodSelect payment methodCredit cardCheckCredit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged. Virtual Symposium Registration 1Personal Information2Payment Information Personal InformationAARC NumberName* First Last Credentials* CRT RRT NPS ACCS SDS RPFT CPFT RPSGT MD DO RN Student Other Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Employment InformationFacility / School Job FunctionDirector / ManagerEducation CoordinatorProgram DirectorDirector Clinical EducationFacultySupervisor/LeadStaff TherapistSenior TherapistSales / MarketingStudentVSRC Board MemberJob settingHospitalSubacute / long term careCollege / universityHome CareSleep labPhysician officeIndustryPFT labOtherVSRC Board Position President President-Elect Past President Vice President Secretary Treasurer Delegate Blue Ridge District Director Central District Director Tidewater District Director Northern District Director Western District Director HiddenDo you require any special accommodations or dietary restrictions?* No Yes HiddenSpecial AccommodationsPlease identify special accommodations. RegistrationRegistration*Select choiceAARC Member 5 daysNon-AARC Member 5 daysStudent 5 daysAARC Member 1 dayNonAARC Member 1 dayStudent 1 dayIf only registering for 1 day, please specify what day. Discount Code Board member, event staff or speakers may enter their discount code.Total $0.00 Payment methodSelect payment methodCredit cardCheckCredit CardCard Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
