Street Address

City, State, Zip

A peek into the life of a 24 week MIcro preemie - from the NICU and beyond.

CME/MEDEK Level III Therapist Registration
Please complete the form below if you are willing to travel for intensives.
In addition to session fees, families cover all travel expenses (airfare, hotel, rental car, meals, visas).

Name

First Name

Last Name

CME/MEDEK Training

What level are you? Who trained you?

First Name

Last Name

What city do you live in?

How long have you been practicing?

Do you specialize in anything else?

i.e. equipment, theratogs, spider cage, taping, etc.

How many sessions are you willing to do over a 5 day intensive?

Typically intensives are 5 days, but if you are traveling a long distance then families like to have a 10-day intensive (with day break half way through).

What is your fee per session?

Are you willing to travel internationally?

What dates are you available to travel?

Please list all dates available in 2020

What is your per diem for meals?

Preferred method of payment?

What other travel requirements do you have?

i.e. arrive X days before the intensive starts, etc.

Cell Number

Country

(###)

###

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Instagram Name

Questions?