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  • ONLINE CEUs
  • August 5th-7th, 2022 In-Person CE Seminar
  • August 5th-7th, 2022 Chiropractic Expo
  • Speakers
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    • Injectable Nutrition
  • About FCPA
    • Mission Statement
    • Meet the FCPA
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    • FL Biennium Requirements
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  • Post author:admin
  • Post published:December 10, 2019
  • Post category:Uncategorized
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    Email: myfcpa@gmail.com

    FCPA Mailing address: 2225 NW 2nd Ave, Cape Coral, FL 33993

    Phone: 407 409 7291

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    Registration form in-person CE Seminar

    In order to report your hours accurately and to receive confirmation from the University, please be sure that your address is current and can be used as the standard USPS format. Please refrain from using all caps when filling out the form.

      First Name: *

      Last Name:*

      Street Address: *

      City: *

      Zip Code: *

      State: *

      Office Phone: *

      Cell Phone Number: *

      Fax:

      FL License Number: *

      Are you a 1st year FL licensee?
      YesNo

      Please enter license issue date:

      Do you have an Out of State License?
      YesNo

      Out of State License Number (please include the State):

      Do you require ACBN Credits?
      Yes (There is a $100 additional fee for ACBN credits)No

      Date of Birth: *

      Email: *

      I am a member of :*
      FCPACPAABoth (FCPA/CPAA)None (FCPA/CPAA)

      Do you believe that chiropractors should have Injectable Nutrition Rights *
      YesNoUndecided

      Registering for *
      August 5th-7th 26CEUs CE SeminarMembershipCE Seminar & Membership

      I have attended an FCPA Seminar in the past *
      YesNo

      How did you hear about us?:*
      By emailReferred by a friendMagazine adPostcardPhone call from FCPA

      Are you interested in getting involved in advancing our laws? *
      YesNo

      I understand that all information regarding the seminar will be sent by email and it is my responsibility to look for and read it.*

      Comments:

        First Name:*

        Last Name:*

        Name of Chiropractic Office:*

        Practice Address:*

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