Dry Needling Course Hosting Request

If you are interested in hosting an IDN course at your facility, please complete and submit the following form.

Your Name*
First Last
Your Email Address*
Your Direct Phone*
Venue Name
Venue Address*
Street Address Address Line 2 City State ZIP Code
Size of Space where the course would be held.*
*Minimum room dimensions are 25'x 40' of wide open space.
Closest major Airport to the venue.*
How many miles from the venue is the airport?*
Course Date - 1st choice*
Date Format: MM slash DD slash YYYY

Courses are 3 full days - Friday, Saturday, Sunday
Course Date - 2nd choice*
Date Format: MM slash DD slash YYYY
Are you interested in hosting a course that is open to the public or a private inservice?*
Number of clinicians you anticipate will attend from your group?*
Please enter a number from 1 to 40.
Your Message
Spam Control*
- Check the box if you are human
Name
This field is for validation purposes and should be left unchanged.