Registration Form

reHeart/reLung Rehabilitation Cardiopulmonary Seminars - 2009-2010

Registration Form

This registration form is for single individual use for one or more courses.

Each full day provides 7.5 contact hours.

Please mail this form & check postmarked 4 weeks prior to course date and payable to:

                                    reHeart/reLung Rehabilitation

                                  12809 NW 79th Street

                                   Kansas City, MO 64152

Name/Title:____________________________________________

PostalAddress:__________________________________________

city_________________________state_____zip_________

EMail:________________________________________________

Phone: (H)_________________(cell)________________

(W)___________________

Course Title

Date/Location

Course Tuition Due

Cardiopulmonary Safety in Home Health & Rehab

>

$

COPD: Effectiveness in Rehab

>

$

CHF: Effectiveness in Rehab

>

$

Cardiopulmonary Combo: COPD & CHF in Rehab

>

$

Pneumonia: Opportunity or Interruption ?

>

$

Dyspnea Control & O2 Use

>

$

EKG Telemetry in Rehab - 2 day course

>

$ 260

Cardiopulmonary Medications

>

$

Ventilator Rehab: Dependency & Effective Weaning

>

$

Auscultation of the Lungs and Heart

>

$

Starting Up: Cardiac and Pulmonary Rehab Programs

(an onsite consultation and staff training)

>your facility

>your date in your timeframe of need

$per diem + travel expenses

TOTAL REMITTANCE $______________

Single Day/person                     $150
2+ courses/person/day                $140
2-day courses (EKG, Review)    $260
APTA members subtract $20/day (APTA membership nmber:__________________)

Questions, comments or personal objectives to the presenter: __________________________________________________________

_________________________________________________________

***___ Would like info to share a room w/ another attendee (check here). Your gender: M F