2020 SCC online registration 2020 Southern Chiropractic Conference Step 1 of 4 - Your Information 25% We are pleased to invite chiropractic students or doctors newly licensed in TN in 2019 to attend educational sessions (not including Boundaries/Ethics course) at no charge. Click here to download a pdf version of registration form.Your InformationName* First Last Practice NameTitle* DC DC Student CTA CXT CTA/CXT Intern LMT CA This field is hidden when viewing the formTitle Entry OneThis field is hidden when viewing the formTitle Entry TwoNote: You selected conflicting titlesDC Lic. #*DC Lic. State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDC Newly Licensed in 2020?* No Yes Additional State DC License(s) StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific#StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific#StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific#CTA Newly Licensed in 2019?* No Yes CTA Lic. #*CXT Lic. #*CXT Newly Licensed in 2019?* No Yes LMT Lic. #*LMT Licensed this year?* No Yes TCA Member?* Yes No TCA Gold Member?* Yes No Discount Opportunities! Contact the TCA to become a member today and save!CAT Member?* Yes No Member of Other State Association Member of Other State Association Assocation's NameTCA is a PACE-recognized provider. For information on which states the SCC is approved for CE, please visit the FAQs page of the SCC website: Will the CE credits earned at the SCC count towards my license renewal?Primary Email* Enter Email Confirm Email Office PhoneBest Contact Number at EventAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Emergency ContactEmergency PhoneIf you have a disability requiring assistance; please describe: Seminar Registration DC Options/Pricing Member Rate Non-Member Rate DCs Licensed this Year Weekend Education Advantage Weekend Education Advantage (24 Hours of Education) $500 $600 FREE Add Acupuncture*Add Acupuncture Yes No Product - Weekend Education Advantage Member Price: Product - Weekend Education Advantage Non-member Price: Product - Weekend Education Advantage DC Licensed Price: Orthopedic Diplomate Training Orthopedic Diplomate Training (Saturday & Sunday, TN course 4 of 5, 10 hrs. total) $250 $350 N/A Product - Orthopedic Diplomat Training Member Price: Product - Orthopedic Diplomat Training Non-member Price: 12 hours CE/non-CE 12 hours CE/non-CE (Select three sessions you will be attending) $275 $375 FREE 12 Hour Select BlocksNote: Select three sessions Fri. AM Fri. PM Sat. AM Sat. PM Sun. AM Sun. PM Product: 12 hours CE/non-CE Member Price: Product: 12 hours CE/non-CE Non-member Price: Product: 12 hours CE/non-CE Licensed Price: 4-hr CE/non-CE 4-hr CE/non-CE (Select sessions you will be attending; they may be either CE or non-CE sessions) $100 (Per Session) $150 (Per Session) FREE Number of 4-hr CE/non-CE sessions*How many 4 hour sessions?Select123456Select Blocks*Note: Limit to number of sessions you selected. Fri. AM Fri. PM Sat. AM Sat. PM Sun. AM Sun. PM Product: 4-hr CE/non-CE DC Sessions Member Price: Product: 4-hr CE/non-CE DC Sessions non-member Price: Product: 4-hr CE/non-CE DC Sessions Licensed Price: Acupuncture Acupuncture (Sunday only) $150 $175 N/A Acupuncture Member Price: Acupuncture Non-Member Price: DC Boundaries/Ethics DC Boundaries/Ethics (Friday only) $150 $150 $150 DC Bounderies/Ethics Price: Note: You selected conflicting class timesNote: You selected conflicting class timesNote: You selected conflicting class timesNote: You selected conflicting class timesNote: You selected conflicting class timesNote: You selected conflicting class timesSeminar Registration Staff Options/Pricing Member Rate Non-Member Rate Intern/Licensed this Year CTA Advanced/ LMT Session CTA Advanced/ LMT Session (CTA must have 3 yrs. licensure or LMT license - Friday Only *hands-on, 50 max capacity) $150 $200 N/A Product: CTA Advanced/ LMT Session Member Price: Product: CTA Advanced/ LMT Session Non-member Price: CTA 6 Hours CE CTA 6 Hours CE (Saturday Only) $125 $175 FREE Staff CTA 6 Hours CE Member Price: Staff CTA 6 Hours CE Non-member Price: Staff CTA 6 Hours CE Intern/Licensed Price: Staff CXT 6 Hours CE CXT 6 Hours CE (Sunday Only) $125 $175 FREE Staff CXT 6 Hours Member Price: Staff CXT 6 Hours Non-member Price: Staff CXT 6 Hours Intern/Licensed Price: CTA/CXT Boundaries/Ethics CTA/CXT Boundaries/Ethics (One-time 2 hr. TN Board required course - Friday Only) $75 $75 $75 CTA/CXT Boundaries/Ethics Price: 4 hrs. Non-CE Option 4 hrs. Non-CE Option $100 (Each Session) $150 (Each Session) FREE 4 hrs. Non-CE Option Selected Blocks*(Select sessions you will be attending) Fri. PM Sat. PM 4 hrs. Non-CE Option Member Price: 4 hrs. Non-CE Option Non-member Price: 4 hrs. Non-CE Option Licensed Price: Note: You selected conflicting class timesPLEASE NOTE: SOME SESSIONS ARE LIMITED TO A MAXIMUM NUMBER OF ATTENDEES NO EXCEPTIONS. SEATING WILL BE FIRST COME, FIRST SERVED.Subtotal $0.00 Conference Totals: Education Total $0.00 Pick up paper notes (add $10):NoYesNotes for all boundaries/ethics courses will be provided in printed form at no charge.Product - Paper Notes Price: Guest/Spouse: Guest/Spouse qualification applies to those individuals who are not registered attendees.Future Leaders Luncheon Future Leaders Luncheon (complimentary lunch for doctors licensed in practice 5 years or less) Number attending Future Leader less 5 years*This field is hidden when viewing the formRapid-Fire Lunch and Learn Rapid-Fire Lunch and Learn (complimentary lunch for doctors licensed over 5 years) Number attending Rapid-Fire over 5 years*This field is hidden when viewing the formSCC Power Up Luncheon – guest/non attendee ticket ($20) SCC Power Up Luncheon – guest/spouse ticket ($20) Guest/Spouse SCC Lunch Power Hour Quantity Price: $20.00 Quantity Southern Nights SCC Social – guest/non attendee ticket (TBA) Southern Nights SCC Social – guest/spouse ticket (TBA) Number attending Southern Nights SCC Social*Donation*A donation to the TCA Foundation is requested (suggested minimum $40) Guest/Spouse Southern Nights SCC Social Quantity Price: $15.00 Quantity Apply Gold Member benefit for 2019 - (Free 12 hours CE annually.) Apply Gold Member benefit for 2019 - (Free 12 hours CE annually.) Gold Member Benefit (deduct $250): $0.00 This field is hidden when viewing the formToday Date MM slash DD slash YYYY After 7/26 (add $50) Price: PaymentConference Total Payment: $0.00 This field is hidden when viewing the formTotal NumClick submit for registrationBilling Address* Street Address Address Line 2 City State ZIP AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name
