Registration Form
IJCAHPO ' s 50 th Annual Continuing Education Program
NAME IJCAHPO ID #
General Information
ON-SITE PACKAGES
ACE 2022 REGISTRATION PACKAGES
3-Day On-Site Package
Includes 3-day access to on-site courses ( Sep 30 – Oct 2 ). Purchase additional on-demand courses for $ 10 per credit hour . List courses below .
Group discount available when registering 3 or more people from the same clinic for the 3-Day On-Site Package . Discount must be requested upon registration — no retroactive discounts will be granted . See page 7 . Names of 2 registrants with non-discounted fees :
________________________________ & _________________________________
Military & Veterans 3-Day On-Site Package
Register by mail or fax only ! Includes 3-day access to on-site courses ( Sep 30 – Oct 2 ). Purchase additional on-demand courses for $ 10 per credit hour . List courses below .
1-Day On-Site Package
Check one : � Friday , Sep 30 � Saturday , Oct 1 � Sunday , Oct 2
Purchase additional on-demand courses for $ 10 per credit hour . List courses below .
Additional On-Demand Courses
Additional on-demand courses are $ 10 per credit hour when purchased with any of the on-site packages above . List courses below .
Certified
( COA , COT , COMT , CDOS , ROUB , OSC , CCOA )
On or Before Sep 29
On-Site
Non-Certified
On or Before Sep 29
On-Site
$ 275 $ 400 $ 375 $ 500 $
$ 175 $ 300 $ 275 $ 400 $
$ 125 $ 225 $ 195 $ 295 $
__________ Credit Hours x $ 10 $
Amount
VIRTUAL PACKAGE
Virtual On-Demand Package
( Oct 3 – Oct 31 ) Over 50 online courses to choose from for a base price plus $ 10 per credit hour . List courses below .
$ 50 base + ___ Credit Hours x $ 10
$ 100 base +
___ Credit Hours x $ 10 $
On-Site Certification Exam Prep Sessions
ACE registration not required for purchase . List courses below .
ADDITIONAL OPTIONS
$ 55 COA /$ 75 COT /$ 95 COMT / $ 95 CDOS & ROUB
On-Site Harold A . Stein , MD Lecture ( Registration Required ) � Yes ! Sign me up . FREE
On-Site Learning Labs
List courses below . __________ Credit Hours x $ 40 $
Hadley Field Trip
Thursday , Sep 29 | Limited Seating Available
� Yes ! Sign me up . FREE
AAO Exhibit Hall Pass $ 200 $ Foundation Donation � $ 1 � $ 5 � Other _________ $
Processing Fee $ 75 $ 75
List All Course Codes to Register
$
Grand Total USD $
By completing this registration and attending ACE 2022 meetings and events , attendees agree to :
• allow their names , likenesses and images ( photographic ) to be used by IJCAHPO for educational and promotional purposes .
• voluntarily assume all health and safety risks related to exposure to COVID-19 and follow all IJCAHPO and hotel protocols .
10 IJCAHPO ' s 50 th Annual Continuing Education Program