Contact us – FCPA

Virtual CE Events Registration

The registration form might take a few seconds to submit, please refrain from pressing the send button repeatedly.

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 the license issue date:

Date of Birth: *

Email (unique per person): *

Do you need credits?:*
YesNo

I am:*
FL DC

Registering for *
Saturday July 27th CE Events

"I understand this is a virtual event and attendance is taken by visual presence. I understand I must remain logged in, engaged, and visible in order to receive CE credit. I also acknowledge that is it my responsibility to have a device with audio-visual capabilities and internet access." *
Read and understood

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

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Registration form

In order to report your hours accurately, 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.

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Florida Chiropractic Physician Association

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Florida Chiropractic Physician Association

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