Step 1 of 3 33% HiddenCurrent Date MM slash DD slash YYYY This event will be held at the Hilton Memphis, June 12-13, 2021Your InformationAttendee Name* First Last Title* DC CTA CXT CA TN Lic. #* TCA Member?* Yes No TCA Gold Member?* Yes No CAT Member?* Yes No Practice/Doctor’s Name Office Phone* Office Fax Email Address* Enter Email Confirm Email Office Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Emergency Contact Relation Phone Do you have a disability requiring assistance* Yes No Please describe: Doctor Registration & Fees12 Hours CE — Saturday and Sunday12 Hour TCA Member: $250.00 - Early Bird (by May 28) 12 Hour TCA Member: $250.00 - Early Bird (by May 28) 12 Hour TCA Member: $300.00 - After May 28 12 Hour TCA Member: $300.00 - After May 28 12 Hour NON Member: $350.00 - Early Bird (by May 28) 12 Hour NON Member: $350.00 - Early Bird (by May 28) 12 Hour NON Member: $400.00 - After May 28 12 Hour NON Member: $400.00 - After May 28 12 Hours CE Price: 8 Hours CE8 Hour TCA Member: $170.00 - Early Bird (by May 28) 8 Hour TCA Member: $170.00 - Early Bird (by May 28) 8 Hour TCA Member: $220.00 - After May 28 8 Hour TCA Member: $220.00 - After May 28 8 Hour NON Member: $240.00 - Early Bird (by May 28) 8 Hour NON Member: $240.00 - Early Bird (by May 28) 8 Hour NON Member: $290.00 - After May 28 8 Hour NON Member: $290.00 - After May 28 Select 2 class blocks for 8 hour CE* Sat AM Sat PM Sun AM 8 Hour CE Price: 4 Hours CE4 Hour TCA Member: $85.00 - Early Bird (by May 28) 4 Hour TCA Member: $85.00 - Early Bird (by May 28) 4 Hour NON Member: $120.00 - Early Bird (by May 28) 4 Hour NON Member: $120.00 - Early Bird (by May 28) 4 Hour TCA Member: $135.00 - After May 28 4 Hour TCA Member: $135.00 - After May 28 4 Hour NON Member: $170.00 - After May 28 4 Hour NON Member: $170.00 - After May 28 Select 1 class block for 4 hour CE* Sat AM Sat PM Sun AM 4 Hour CE Price: Doctor Boundaries — 6 Hours (Sat.)Boundaries, Risk Management & Jurisprudence $150 Boundaries, Risk Management & Jurisprudence $150 Doctor Boundaries Price: HiddenDoctor Registration QTYHidden12 Hours CE QTYHidden4 Hours CE QTYToo many hours selected, please verify your selection(s).Too many hours selected, please verify your selection(s).Too many hours selected for Sunday, please change your Sunday selection(s).CTA/CXT Registration & FeesCAT Membership (renewal or new)CAT Membership $50.00 CAT Membership (Send application after payment if new member) $50.00 CAT Membership Price: CTA/CXT Boundaries — 2 Hours (Sat.)**Boundaries, Risk Management & Jurisprudence $75.00 Boundaries, Risk Management & Jurisprudence $75.00 Boundaries, Risk Management & Jurisprudence Price: CTA — 6 Hours CECTA — 6 Hours CE - CAT Member Early Bird $100 (by May 28) CTA — 6 Hours CE - CAT Member Early Bird $100 (by May 28) CTA — 6 Hours CE - NON Member Early Bird $150 (by May 28) CTA — 6 Hours CE - NON Member Early Bird $150 (by May 28) CTA — 6 Hours CE - CAT Member $150 - After May 28 CTA — 6 Hours CE - CAT Member $150 - After May 28 CTA — 6 Hours CE - NON Member $200 - After May 28 CTA — 6 Hours CE - NON Member $200 - After May 28 CTA — 6 Hours Price: Hidden8 Hours CE selected totalHiddenDoctor Boundaries Sat selected totalError: Two Sat classes selected.Subtotal $0.00 HiddenContinue SubtotalNote: Add class to continue. Use Gold Member Benefit for 2021?Apply Gold Member benefit for 2021 - (Free 12 hours CE annually) Apply Gold Member benefit for 2021 - (Free 12 hours CE annually.) Gold Member Benefit (deduct $250): $0.00 Total Payment $0.00 HiddenTotal of formBilling Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Billing Email* Billing Phone*Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Thank you for your registration! We look forward to seeing you in Memphis.