Virtual Seminar-Zooming to CE

Zoom for CE! Register for the seminar and earn 3 Category A CEs.

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Workshop Registrant Information

First Name *

Middle Name

Last Name *

Email *

Home Address *

Home City *

Home State *

Zip Code *

Preferred Phone *

Cell

Credentials

Please enter here how you would like your credentials shown on printed material.

Event Fee(s) *

OSRT Member Rate - $ 15.00

Non-member Rate - $ 30.00

Student Rate - $ 10.00

Total

Credit Card

If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page.

Checkout securely. Pay without sharing your financial information.

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *