American BackPain Center   

          Treatment, Education, and Research of the Spine

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                          (Last)                                (First)

Medical Profession:   MD  DO  PA  PT  PTA  OTR  ATC

                                         (Circle Degree)

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E-Mail      _______________________________________

Employer  _______________________________________

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Course Location __________________________________

                                               (City)

Registration Fee:   $ 695

     $750 if received less than 14 days

                                                prior to the course.

Make Check Payable To:   American BackPain Center

            

Send Check & Registration To: American BackPain Center                                                      PO Box 101

                                             Anchorville, Michigan

                                             48004

Strategic Orthopedics:  Lumbar Course I

Registration Form

If you prefer to register by mail or fax, copy the registration form below, fill it out and mail to our address listed at the bottom of this form, or fax to us at (586) 716-8852