REGISTRATION FORM for:
Doctors of Chiropractic, Students and Chiropractic Assistants


N.B.: Four or more seminar attendees coming from a same practice "team" qualify for a group discount!
Please consult Team Practice Registration Form"

PARKER SEMINARS ITALY 2010
JUNE 24-26 ROME, ITALY

Melia’ Roma Aurelia Antica Hotel and Convention Center

Via degli Aldobrandeschi, 223 - 00163 ROMA
Tel:+39 06 66544 - Fax:+39 06 66544476

Last name: First name(s):
Company name:
Street: P.O. Box:
City: Postal Code:
Country:
Telephone (international):
Fax:
E-mail:
College*: Year of graduation:
If Chiropractic Assistant, please list the primary Doctor’s name:

* D.C. applicants for the Seminar must be graduates from CCE, ECCE or CCEI accredited Colleges. Non qualified applicants will be charged a 15% administrative fee from eventual refunds.

Registration fees : Paid by
May 8th 2010
Paid after
May 8th 2010
Num. of
persons
Total
Euro
Doctor of Chiropractic Euro 460,00 Euro 550,00
Students (limited to 50) Euro 180,00 Euro 210,00
Parker College students Free Euro 120,00
Chiropractic Assistants Euro 249,00 Euro 289,00
Licence renewal processing: Euro 80,00
Registration fee includes Coffee Breaks, Friday and Saturday lunches for all delegates
Special Diet Requirements: vegetarian gluten free
LOGISTICS - The SEMINAR OPENING SESSION finishes at 8:00 PM on Thursday. The Tapas Dinner is a natural follow-up! Instead, Friday’s lectures finish at 5:30 PM which provides time for an evening in Rome.
Social Programme No. 1 Date Euro Number Total Euro
Tapas Pool Party Dinner Thurs. June 24th 89,00
Tapas Pool Party D.- child 12 & under Thurs. June 24th 40,00
Sub Total: Euro
Coupon deduction **: Euro
TOTAL TO BE PAID: Euro
** If you have been granted a PSI 2010 coupon, you must demonstrate the coupon with your registration.
 
PAYMENT DETAILS:
Credit card for the total due (in €): VISA Master Card
Cardholder’s name:
Credit card number:
Last digits on the signature panel
of the credit card:
Expiry date (MM/YY): Cardholder Signature:
Bank transfer payment:
Association of Italian Chiropractors
Banca Popolare di Novara Ag.5
IBAN: IT20M0560801405000000020314
SWIFT: NVRBIT21035
   
 
Cancellation Policy: refunds and/or transfers less a 25 percent administrative charge will be issued upon request if received before May 20, 2010
There will be no refunds or transfers permitted after that time;
  • Parker Seminars reserves the right to adjust program dates, times, speakers and/or locations:
  • The total liability of Parker Seminars arising from or related to these courses is limited to a refund of the registration fee only:
  • Parker College of Chiropractic will not complete vouchers for continuing education credit until seminar tuition is paid in full:
  • The opinions and statements made by the speakers do not necessarily reflect the opinions of the Parker Seminars.
Privacy Policy:
The personal data sent by the participants directly or indirectly to Associazione Italiana Chiropratici is protected by the Italian Legislative Decree no.196 of 30 June 2003, "Personal Data Protection Code" which protects persons and other subjects with regard to the handling and processing of personal data and, therefore, will be used for administrative, accounting, commercial and promotional purposes. The holder and handler of personal data processing are:
  • Associazione Italiana Chiropratici with head office in Via Brigata Liguria, 1/20 Genova;
  • Parker Seminars with head office at Parker College of Chiropractic 2500 Walnut Hill Lane, Ste. S-209 Dallas, TX 75229
 

HOTEL ACCOMMODATIONS:
REMEMBER TO BOOK YOUR HOTEL !

In order to make your Parker Seminars Italy a hassle-free full emersion experience, we highly recommend that you book your room within the Convention Site at one of the two hotels that we have secured.

Please complete separate "HOTEL BOOKING FORM"
And fax or email the document directly to the hotel