Registration Form - 2025 Symposium - American Chiropractic Board of Sports Physicians

Attendee Personal & License Information

First Name

Last Name

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Personal Email

Business Email

Business Phone

Cell Phone

What state(s) are you licensed in? Please list all states where you are currently licensed to practice.

Please list your DC license number(s) for all states listed above. Please list all states then the corresponding license number(s) where you are licensed to practice.

Badge Information

Badge Name - How you want your name printed on your badge including any credentials/certifications?

List any credentials for display on your badge in the order you want them to appear on your badge (e.g. DC, CCSP®, DACBSP®, CSCS®, ATC).

What city and state abbreviation should appear on your badge?

I have reviewed and proofread my badge information and understand that badges will NOT be printed on site at the symposium.

Yes

Continuing Education Information: Completion Certificates

Do you require a CEU completion certificate for attending the 2025 Chiropractic Sciences Symposium from our CEU sponsor?

Yes

No

Do you require a CEU completion certificate from BOC?

Yes

No

Do you require a CEU completion certificate from NSCA?

Yes

No

Are you a DC student?

Yes

No

If you answered yes to the above question, please list the name of your college/program here.

Lodging & Miscellaneous Information

How did you hear about the 2025 Chiropractic Sports Sciences Symposium?

Permission for the National Office to share your business contact information with the vendors that attended the event?

Yes

No

If you answered yes to the question above, what information would you like the national office to share with the vendors that attended the symposium to include name and email address. **If you answered no, please enter N/A in the next two fields.**

By typing my name in the field below, I consent to allow the ACBSP to use my image in photographs taken at the 2025 CSSS in digital and / or print media. The photographs including my image may be used by the ACBSP at no charge; however, the image may not be sold, shared or reproduced by any party other than the ACBSP.

Symposium Registration Options:

Below are the different symposium registration options.

Wednesday: March 26, 2025 - Principles and Practices Workshop - Only

The Principles and Practices Workshop (PPW) is geared towards the practical examination. This year the workshop will feature the following presentations: Field Concussion Evaluation - 2 hour block; Special Populations - 2 hour block; Extremities- 2 hour block; and Emergency Procedures - 2 hour block