Registration Form
IJCAHPO ' s 49 th Annual Continuing Education Program
NAME IJCAHPO ID #
General Information
ON-SITE PACKAGES
ACE 2021 REGISTRATION PACKAGES
3-Day On-Site Package
Includes 3-day access to on-site courses ( Nov . 12-14 ) + 3 exclusive bonus on-demand courses . 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 & Veteran 3-Day On-Site Package
Register by mail or fax only ! Includes 3-day access to on-site courses ( Nov . 12-14 ) + 3 exclusive bonus on-demand courses . Purchase additional on-demand courses for $ 10 per credit hour . List courses below .
1-Day On-Site Package
Check one . � Friday , Nov . 12 � Saturday , Nov . 13 � Sunday , Nov . 14
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 , ROUB , CDOS , OSC , CCOA )
Non-Certified
$ 275 $ 375
$ 175 $ 275
$ 125 $ 195
__________ Credit Hours x $ 10 $
Amount
$
$
$
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VIRTUAL PKG
Virtual On-Demand Package
( Oct . 28 – Nov . 21 ) Over 50 online courses to choose from . List courses below .
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$ 50 base + $ 10 per credit hr . |
$ 100 base + $ 10 per credit hr . |
$ |
Miscellaneous
On-Site Certification Exam Prep Courses
ACE registration not required for purchase . List course below .
$ 55 COA /$ 75 COT /$ 95 COMT $
On-Site Harold A . Stein , MD Lecture ( Registration Required ) � Yes ! Sign me up . FREE
Virtual Demonstration Labs
List courses below . __________ Credit Hours x $ 10 $
AAO Exhibit Hall Pass $ 200 $ Foundation Donation � $ 1 � $ 5 � Other _________ $
Processing Fee $ 75 $ 75
Grand Total USD $
By completing this registration and attending ACE 2021 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 hotel protocols .
List All Course Codes to Register
10 IJCAHPO ' s 49 th Annual Continuing Education Program