Course Registration

Our courses are specifically designed for clinicians and therapists that specialize in pediatrics. If you are currently seeing less than 25% pediatric patients, we ask that you please refrain from registering to save space for those who will benefit the most from the course. Thank you.

* Required Field
*First Name:
*Last Name:
*Address:
*City: *State: *Zip Code:
*E-mail:

Certificates of completion will be sent to this E-mail address
*Clinic/Facility Name:
Facility Address:
*Phone (999-999-9999):
*I am a:

*Job Title:

*Have you ever attended a SureStep InService before:

*Do you currently work in the Early Intervention Program in your state?

If yes, what is the name of this program?

*What percentage of pediatrics are you currently doing?

*What is the name of the Orthotist you use for your bracing needs?

License No.

*How did you hear about this course?