Orthopedic Injection Workshop Application

Please provide the information requested in the following form.

Required fields indicated by an asterisk (*).

Fees

Once you have selected a course date, click on the 'Submit' button at the bottom of the form.  You will be taken to a PayPal fullfillments page where you can satisfy your tuition requirement.  PayPal should provide an email confirmation/receipt of your payment.

Course Locations and Times

The course usually runs from 9a-5p with an hour break for lunch.  Our location may vary within the Oakland/Berkeley area.  You will receive a follow-on email confirming times and giving directions and other logistical information sometime in the week prior to the class.

Thank you for your application!

Only to be used to contact you regarding this enrollment.
Please enter your certification, degree, or educational program or institution in which you are currently enrolled here.
If registering as a student, please provide your student ID number here, as well as any license number.