REGISTRATION FORM
Beyond Bands Evidence-Based Progression of
Elastic & Proprioceptive Exercises
February 6, 2010
Name _______________________________________
Professional License Number_____________________
Address _____________________________________
City ________________State_______Zip___________
Phone ______________________________________
E-mail _______________________________________
Check one:
❑ Physical Therapist - $175
❑ Upstate Affiliated Clinical Instructor (PT) - $140
❑ Physical Therapist Assistant - $175
❑ Student - $100
Make checks payable to: Faculty Student Association (FSA)
Send registration form and payment to:
David Hawley Student PT
105 Elizabeth Blackwell St. Room 726
Syracuse NY, 13210
Registration Deadline: 1/29/10
Additional registration forms can be downloaded from the Thera-Band website at this
address: http://info.thera-bandacademy.com/beyondbands
• For information about the course contact Erinn Durst Student PT at: (585)260-8754 or
email DurstE@upstate.edu
• For driving directions, please visit:
http://www.upstate.edu/uh/patients/directions_ihp.php
• Parking will be provided on the day of the course in the rear of the building.
A portion of the proceeds from the course will go to the Marquette Challenge. In 1989,
Marquette University created the Marquette Challenge as a call to all physical therapy
schools to raise money for physical therapy research. Donations made to the challenge
go to fund annual research grants that are awarded to emerging physical therapist
investigators. This Challenge is entirely student-run; therefore, the planning, overseeing,
and executing of fundraising events are up to the students. All money raised on behalf
of the SUNY Upstate Medical University-Marquette Challenge will be donated to the
Foundation for Physical Therapy.
These hotels are located within a short drive from the Institute for Human Performance
and discounts may apply, email Erinn Durst for details:
Sheraton Syracuse University Hotel & Conference Center
801 University Ave.
Syracuse, NY 13210
475-3000
Register before January 15th, and state that you are coming for the Beyond Bands
course at Upstate Medical.
Renaissance Syracuse
701 E Genesee St.
Syracuse, NY 13210
479-7000
Ask for the SUNY rate.
Genesee Grand Hotel Syracuse
1060 E Genesee St.
Syracuse, NY 13210
(315) 476-4212