GOLD SPONSORS
Vanderbilt
SILVER SPONSORHuman Technology, Inc.
EXHIBITORS
Fourroux
ATI
North Mississippi Medical Center
West Tennessee Health Care
Dynatronics
Reconnect Therapy
Continuing Educationand
Fall Meeting
ScheduleThursday September 24, 2015
EC Meeting5:00pm – 8:30pmDoubletree - Jackson, TN
Friday and Saturday classes and meetings - Jackson Madison County General Hospital
Friday September 25, 2015
Registration and Check-in7:00am
Medical Screening for Referral: DifferentialDiagnosis for Direct AccessDavid Sheer, PT, DPT, MOMT15 Contact HoursFriday 7:30am – 12:00pm, break for lunch,1:00pm – 5:00PMSaturday 7:45am – 12:30pm, break forlunch, 1:45pm – 5:00pm
Transition to ICD-10…Don’t Panic, Prepare!!Tabitha Harris, PT, DPT, OCS and Steven E. Spinks, PT, DPT, COMT3 Contact Hours8:30am – 11:45am
Advancing your Neurologic Practice:Neurorehabilitation in the 21st centuryRenee Brown, PT, PhD8 contact hours8:00am – 12:30pm, break for lunch, 1:00pm – 5:00PM
ORTHO TRACK
Cartilage Restoration Surgery Present andFutureJason Hutchison, MD1 Contact Hour8:00am – 9:00am
Ligaments are an Injury Too!Cameron Knight, MD1 Contact Hour9:15am – 10:15am
Manual Therapy Therapy for the ShoulderPenny Head, PT1 Contact Hour10:30am – 11:30am
Overcoming Barriers to Clinical ResearchJune Hanks, PT, PhD, DPT, CWS, CLT1 Contact Hour11:00am – 12:00pm
Lunch BreakDistrict Chair Meeting12:00pm – 1:00pm
Gait Across the LifespanAudrey Zucker Levin, PhD, PT, MBA, GCSEmeritus4 Contact Hours1:00pm – 5:15pm
BOD Meeting1:00pm – 3:00pm
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**Course times and coursetitles are subject to change
ORTHO CONT.
Imaging Perspectives on InternalDerangements of the KneeTony Ghodadra, MD1 Contact Hour1:00pm – 2:00pm
Neurological Advances in ImagingThomas Markel, MD2:15pm – 3:15pm
Physical Therapy of Dance Heather Herod Cole, MS, PT, COMT, CPI1.5 Contact Hours3:30pm – 5:00pm
PAC EventJoin the TPT-PAC atMiss Ollie’s - Downtown Jackson111 E Lafayette StWith Entertainment by
Dirt Pilgrims5:30 – 8:30Admission $25 PAC ContributionAppetizers and Drinks Available
Saturday September 26, 2015
Medical Screening for Referral, Cont.David Sheer, PT, DPT, MOMT15 Contact Hours7:45am – 12:30pm, break for lunch, 1:45pm – 5:00pm
Emerging Practice Trends for the PTAJane David, PT, DPT, MS2 Contact Hours8:00am – 10:00am
Evidence-informed Dry Needling ReviewHannah Norton, PT, DPT, OCS, FAAOMPT and Christina Myers, PT, DPT, OCS, Cert.MDT, CIMT7.5 Contact Hours*Basic Dry Needling Continuing Education Required8:00am – 12:00pm, break for lunch, 1:45 – 5:00pm
Jurisprudence – The Legal Basis of PhysicalTherapy PracticeBaron Johnson, PT2 Contact Hours10:00am – 12:00pm
Concussion from the Physician's PerspectiveScott Johnson, MD1 Contact Hour10:30am – 11:30am
STUDENT EVENT "Y we need U: Transforming TPTA" Joe Black, PT, DPT 11:30am – 12:15pm
Lunch BreakDelegates Meeting12:00pm – 12:45pmExhibitor Bingo – Grand prize to be given at Chapter Business Meeting
Chapter Business Meeting12:45 – 1:30pm
Concussion – Athlete & Community DwellerDanny Smith, PT, DHSC, OCS, SCS2 Contact Hours1:45pm – 3:45pm
EthicsBaron Johnson, PT2 Contact Hours1:45pm – 3:45pm
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Medical Screening for Referral:Differential Diagnosis for Direct AccessDavid Sheer, PT, DPT, MOMT
BIODavid Sheer has been a practicing cliniciansince 1978 and has specialized inorthopedic manual therapy since 1991. Heearned his Masters in Orthopedic ManualTherapy after completed the 4 yearresidency and fellowship program with theOla Grimsby Institute. He was an author ofthe original course work for the OGI andtaught as a primary instructor in theresidency program for 12 years. Davidreceived his Doctorate of Physical Therapythrough the OGI.
Transition to ICD-10…Don’t Panic,Prepare!!Tabitha Harris, PT, DPT, OCS andSteven E. Spinks, PT, DPT, COMT
TOPICTransitioning from ICD-9 to ICD-10:Coding for PT, OT and SLP (with focus onoutpatient settings)
TARGET AUDIENCEPT’s, OT’s, SLP’s (PTA’s/COTA’s may attendcourse for informational purposes butwould not be “coding” therapy conditionsin treatment settings).
OBJECTIVES OF COURSE• Understand the history of ICD-10• Understand and describe the primarydifferences between ICD-9 and ICD-10• Ability to apply correct ICD-10 codingconcepts to PT, OT and SLP (outpatient
specific)• Ability to report and bill ICD-10 codesappropriately (outpatient specific)• Identify when a 7th character is requiredin ICD-10 coding• Define initial & subsequent encounterand sequela• Apply appropriate documentationprinciples to support ICD-10 codes• Ability to identify, find and utilizeappropriate resources for ICD-10 coding
OUTLINEI. IntroductionII. History of CodingIII. Why change now?
a. Who has to transitionIV. Benefits of ICD-10 transitionV. ICD-9 vs ICD-10
a. Major differencesb. Placeholdersc. 7th characters
VI. Implementation of ICD-10a. Impact on CPT codes?b. Claim form revisions
VII. Coding toolsa. General Equivalency Mappings
(GEMs)b. ICD-10 Coding books
VIII. Coding Guidelinesa. Generalb. Alphabetical Index
b.i. Commonly used chaptersc. Tabular Index
c.i. Treatment diagnosesc.ii. Medical diagnoses/co-
morbiditiesc.iii. Injuries and external
causes
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Courses
IX. Documentation guidelines and tipsX. Implementation StrategiesXI. Conclusion/Contact information
BIOS Tabitha graduated from University ofTennessee at Chattanooga in 1996 with herBS in Physical Therapy and has been apracticing physical therapist in Chattanoogaand surrounding area since that time. Shehas since completed an orthopedicresidency program through EIM andobtained her DPT through Regis University.Tabitha’s primary practice experience hasbeen in outpatient settings but has alsoincluded time in home health, SNF’s andhospital acute and subacute facilities. Shehas been involved in the start-up of severalnew therapy facilities and has worked as thedirector of outpatient therapy clinics for thelast 14+ years of her career. She hasrecently transitioned into a role with thecompliance department for BenchMarkRehab Partners. Tabitha has been heavilyinvolved in the development and training ofthe ICD-10 transition plan for her company.She currently lives in Chattanooga,Tennessee with her husband David, 4children, 2 cats and one dog.
Steven graduated from The University ofTennessee Health Science Center inMemphis, Tennessee, in 2013. He is
currently the clinicdirector for two ofBenchMark Physical
Therapy’s clinics ineastern Tennessee and
is the membership chairfor the Tennessee
Physical TherapyAssociation. He is
currently a Resident inBenchMark Rehab Partner’sOrthopedic Residency
program and enrolled in Evidence inMotion’s Manual Fellowship program. He isa certified Orthopedic Manual Therapistthrough Maitland Australian PhysiotherapySeminars and certified in dry needling. Hehas worked on the ICD10 Task Force forBenchMark Rehab Partners and has beeneducating clinicians regarding ICD10alongside of Tabitha Harris. He is partowner of a CrossFit box in Athens,Tennessee and spends his free timecoaching at his CrossFit gym and eating.
Advancing your Neurologic Practice:Neurorehabilitation in the 21st CenturyRenee Brown, PT, PhD
COURSE DESCRIPTIONAs research in neurologic rehabilitationevolves, clinicians are challenged to keepup with the latest advances and tounderstand how to apply some of the latestresearch to their clinical practice. Thiscourse will review basic neuroanatomy,discuss current imaging technology whichis providing a more comprehensive view ofthe brain. It will cover current literature onmotor control, motor learning, andneuroplasticity and how to apply theseprinciples on Monday in the clinic.Evidence for high intensity exercise will beexamined. Newer techniques such astranscranial cranial magnetic stimulation,robotics, brain-computer interface, split-belt treadmill, and virtual reality will bediscussed. Active learning exercises will beincorporated throughout the session.
COUSE OBJECTIVESUpon completion of this course theparticipants will be able to:
1. Describe the location, connections, andfunctions of neuroanatomical structures
4
2. Differentiate the different neuroimagingtechniques
3. Define motor control and thecomponents/constraints
4. Discuss the factors that can affectneuroplasticity
5. Apply the principles of motor learningto a case
6. Evaluate how to incorporate highintensity exercise with patients
7. Discuss emerging trends andtechnology for neuro rehabilitation
BIODr. Brown has been a practicing clinicianfor 32 years specializing in NeurologicRehabilitation. She received her B.S inphysical therapy from Daemen College,advanced MS in neurologic rehabilitationfrom the University of North Carolina atChapel Hill and her PhD in Neurosciencefrom the University of Texas at Dallas. Dr.Brown currently is the Chair of the Schoolof Physical Therapy at Belmont Universityand is the Academic Director of theNeurologic Residency at Vanderbilt PiBeta Phi Rehabilitation Institute andBelmont University. She has donenumerous presentations on topicsincluding Motor Control and MotorLearning and Neuroplasticity.
Cartilage Restoration Surgery Presentand FutureJason Hutchison, MD
Ligaments are an Injury Too!Cameron Knight, MD
Manual Therapy Therapy for theShoulder Penny Head, PT
Overcoming Barriers to ClinicalResearch June Hanks, PT, PhD,DPT, CWS, CLT
Gait Across the LifespanAudrey Zucker Levin, PhD,PT, MBA, GCS Emeritus
Imaging Perspectives onInternal Derangements ofthe KneeTony Ghodadra, MD
Neurological Advances in ImagingThomas Markel, MD
Physical Therapy of Dance Heather Herod Cole, MS, PT, COMT, CPI
Emerging Practice Trends for the PTAJane David, PT, DPT, MS
Evidence-informed Dry Needling ReviewHannah Norton, PT, DPT, OCS, FAAOMPTand Christina Myers, PT, DPT, OCS, Cert.MDT, CIMT
COURSE OUTLINEBrief mechanism reviewBrief technique reviewUQ evidenceUQ lab - regional reviewsCase Study LQ evidenceLQ lab - regional reviews
BIOS Hannah Norton: Hannah holds a Doctorateof Physical Therapy from Rocky MountainUniversity of Health Professions. Shecompleted an orthopedic residency
5
Attention all licensed PTA’s!
Please join the PTA SIG committeeat the Fall Meeting for a social
gathering from 8pm-9pm at “Twist”in the Double Tree Hotel. This willbe a great time to network withyour peers as well as discuss therecent vote by the APTA House ofDelegates to allow chapters theright for PTA’s to have a full vote.
program and obtained board-certification in orthopedics, and is
a Fellow of the American Academyof Orthopedic Manual
Physical Therapists.
Hannah currently serves ascore faculty with South College DPTprogram and BenchMark Rehab
Institute Orthopedic PhysicalTherapy Residency andFellowship Programs,
teaching dry needling andorthopedic managementcoursework.
Christina Myers: Clinicianwith 14 years of experience
in orthopedics including certifications in theMcKenzie method, manual therapy, theOCS designation, and 5 years of dryneedling. Currently finishing up anorthopedic manual physical therapyfellowship with Evidence in Motion.Practicing at BenchMark Physical Therapyin Georgia for the past 12 years. Adjunctfaculty with the University of Tennessee atChattanooga as well as faculty for theBMRP orthopedic residency program.
Jurisprudence – The Legal Basis ofPhysical Therapy PracticeBaron Johnson, PT
Concussion from the Physician’sPerspectiveScott Johnson, MD
STUDENT EVENT - "Y we need U: Transforming TPTA" Joe Black, PT, DPTConcussion – Athlete & CommunityDweller Danny Smith, PT, DHSC, OCS, SCS
COURSE OUTLINEIntroductionAcute Signs and SymptomsAcute (on the field) managementAcute (on the sidelines) managementPost Injury Recognition Concussion and Orthopedic Trauma in theCommunityPost Injury Management- Athlete andCommunity Dweller
EthicsBaron Johnson, PT
6
Conference Information
Make your reservations by mailing or faxing (615-297-5852) the attached registration form to the TPTA Office.
For more information, contact the TPTA office at [email protected] or 615-269-5312.
Registrations may also be downloaded from the TPTA website www.tptatn.org.
Course certificates will be given out at the end of each course. If you do not pick up your certificate at the end of the course, you will
not receive full credit for the course without proof of completing the course.
CancellationCancellations will be accepted until Sept. 22, 2015.
A refund minus $25 of registration monies is honored through Sept 22, 2015. No refund will be given after Sept 23, 2015.
HOTELSDoubletree
1770 Highway 45 Bypass– Jackson TN
$99 a night – 731-664-6900
Group name: Tennessee Physical Therapy Association
AllSuites Hotel
541 Carriage House Drive, Jackson, TN 38305
$70 night – 731-668-6000
Group name: Tennessee Physical Therapy Association
Fairfield Inn & Suites
1335 Vann Drive, Jackson, TN 38305
$99 night – 731-736-4550
Group name: Tennessee Physical Therapy Association
You can also go to TPTATN.org and click on Meetings/Events TPTA Fall Meeting and there will be a direct link to register.
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COURSES & PRICES (Please check the courses you are interested in taking)
� Medical Screening for Referral: Differential Diagnosis for Direct AccessDavid Sheer, PT, DPT, MOMT15 Contact HoursFriday 7:30am to 12:00pm, break for lunch, 1:00pm to 5:00pmSaturday 7:45am – 12:30pm, break for lunch,1:45pm – 5:00pm
� Transition to ICD-10… Don’t Panic, Prepare!!Tabitha Harris, PT, DPT, OCS and Steven E. Spinks, PT, DPT, COMT3 Contact HourFriday 8:30am – 11:45am
� Advancing your Neurologic Practice: Neurorehabilitation in the 21st centuryRenee Brown, PT, PhD 8 contact HoursFriday 8:00am to 12:30pm, break for lunch,1:00pm to 5:00pm
ORTHO TRACK - FRIDAY
� 8:00am – 9:00amCartilage Restoration Surgery Present and FutureJason Hutchison, MD1 Contact Hour
� 9:15am – 10:15amLigaments are an Injury Too!Cameron Knight, MD1 Contact Hour
� 10:30am – 11:30amManual Therapy Therapy for the ShoulderPenny Head, PT 1 contact Hour
� 1:00pm – 2:00pmImaging Perspectives on InternalDerangements of the KneeTony Ghodadra, MD1 Contact Hour
� 2:15pm – 3:15pmNeurological Advances in ImagingThomas Markel, MD1 Contact Hour
� 3:30pm – 5:00pmPhysical Therapy of DanceHeather Herod Cole, MS, PT, COMT, CPI1.5 Contact Hour
� Overcoming Barriers to Clinical ResearchJune Hanks, PT, PhD, DPT, CWS, CLT1 Contact HourFriday 11:00am – 12:00pm
� Gait Across the LifespanAudrey Zucker Levin, PhD, PT, MBA, GCS Emeritus4 Contact HoursFriday 1:00pm – 5:15pm
� Emerging Practice Trends for the PTAJane David, PT, DPT, MS2 Contact HoursSaturday 8:00am – 10:00am
� Evidence-Informed Dry Needling ReviewHannah Norton, PT, DPT, OCS, FAAOMPT and Christina A. Myers, PT, DPT, OCS, Cert. MDT, CIMT,FAAOMPT7.5 Contact HoursSaturday 8:00am – 12:00pm, break for lunch, 1:45 – 5:00pm
� Jurisprudence – The Legal Basis of PhysicalTherapy Practice Baron Johnson, PT2 Contact HoursSaturday 10:00am – 12:00pm
� STUDENT EVENT "Y we need U: Transforming TPTA" Joe Black, PT, DPT Saturday 11:30am – 12:15pm
� Concussion from the Physician’s PerspectiveScott Johnson, MD1 Contact HourSaturday 10:30am- 11:30am
� Concussion - Athlete & Community DwellerDanny Smith, PT, DHSC, OCS, SCS2 Contact HoursSaturday 1:45pm – 3:45pm
� EthicsBaron Johnson, PT2 Contact HoursSaturday 1:45pm – 3:45pm
PT Member . . . . . . . . . . . . . . . .$385 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . .$585 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . .$240 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . .$392 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . .$128 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$200 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$45 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$73 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$24 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$38 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . .$120 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . .$196 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$64 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . .$100 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PTA Member . . . . . . . . . . . . . . . .$32 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$50 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . .$225 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . .$367 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$50 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$20 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$50 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Student . . . . . . . . . . . . . . . . . . . . .$00 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$30 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$49 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$60 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$98 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$32 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$50 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PT Member . . . . . . . . . . . . . . . . .$25 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PT NonMember . . . . . . . . . . . . .$50 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA Member . . . . . . . . . . . . . . . .$20 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _PTA NonMember . . . . . . . . . . . .$50 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Student . . . . . . . . . . . . . . . . . . . . . .$0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
BOX LUNCH: (Included for Friday and Saturday)Please check below or no lunch will be provided.
Friday, September 25 � YES � NOSaturday, September 26 � YES � NO
� Social Registration (Not Attending Classes)Includes: Breakfast, Lunch, Exhibits and Chapter Business
Meeting Saturday 12:45pm-1:30pm $25_______________
� PAC Event Please check box if you plan to attend.Friday night 5:30 -8:00 $25_______________
Students - Check the courses you wish to attend$25_______________
Total Paid: $___________________
To register, detach this completed registration form and send it along with payment to:
Tennessee Physical Therapy Association4205 Hillsboro Road, Suite 317Nashville, TN 37215
for more information or to register by fax:Phone: 615-269-5312 • Fax: 615-297-5852
download registration form at:tptatn.org
REGISTRATION (please type or print neatly)
Name: _____________________________________________________________________________________________________________________________
Company: _______________________________________________________________________________________________________________________
Address: __________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________
City: ___________________________________________________________ State: ______________ Zip: _______________________________
Phone: __(________________)_____________________________________________ Fax: __(________________)_______________________________________________
Email: ______________________________________________________________________________________________________________________________
Check One:
� PT Member � PT Nonmember � PTA Member� PTA Nonmember � Student Member � Student Nonmember
APTA Member #: __________________________________________________________________________________________________________
Payment Method:
� Check enclosed (Payable to TPTA) � VISA � MC � AMEX
Account #: __________________________________________________________________ Exp. Date: ___________________/_______________/___________Name of Cardholder: _____________________________________________________________________________________________________
Billing Address of Cardholder: _____________________________________________________________________________________
____________________________________________________________________________________________________________________Total Paid: $ ______________________________
Disclosure: By registering for this meeting the attendee acknowledges and provides the TPTApermission to do random video taping and photography for marketing and promotional purposes.
Friday and Saturday classes and meetings - Jackson Madison County General Hospital
Basic Dry Needling Continuing Education Required