Certification Program - PDF by qpeoru8364


                                                                                                                                                                                                 (continuing education)

Non-Profit Org.

Permit No. 268
 Wheeling, IL
 U.S. Postage

                                                                                                                                                       Kinesio Taping
                                                                                                                                                         Lincoln College of Postprofessional, Graduate
                                                                                                                                                                  and Continuing Education

                                                                                                                                                                Certification Program
                                                                                                                                                         A Kinesio ® USA, LLC authorized program

                                                                                                                                                          Session 1: November 7 - 8, 2009
                                                                                                                                                                  KT1 Fundamentals of Kinesio Taping®
                                                                                                                                                           KT2 Advanced Kinesio Taping® Corrective Techniques

                                                                                                                                                          Session 2: December 5 - 6, 2009
                                                                                                                                                                      KT3 Advanced Kinesio Taping®
                                                                                                                                                                  KT of Dysfunctional Movement Patterns

       Lincoln College of Postprofessional, Graduate

                                                                                                                                                                      East Brunswick, NJ
       www.nuhs.edu (continuing education)

                                                                                                            • November 7 - 8, 2009 (KT1 & KT2)
                                                                                                            • December 5 - 6, 2009 (KT3)

                                                                                       East Brunswick, NJ
                                                               Certification Program
                                                       Kinesio Taping®

                                                                                                                                                                         Vince DeBono, DC, CSCS
       200 East Roosevelt Road
       Lombard, IL 60148-4583
       and Continuing Education

                                                                                                                                                                         David Parish, DC, CSCS, DACBSP
                                                                                                                                                                         Certified Kinesio Taping® Instructors

                                                                                                                                                                       NUHS is accredited by the Higher
                                                                                                                                                 Learning Commission of the North Central Association of Colleges and Schools.
                                                                                                                                                    30 N. LaSalle St., Suite 2400, Chicago, IL 60602-2504 • 800-621-7440
                                                                                                                                                     FPTA Provider ID Number: 50-4321 • IL DPR PT License# 216.000133
I                    Kinesio Taping® CERTIFICATION                                                                 Kinesio Taping® REGISTRATION FORM (NJ)
           NOVEMBER 7 - 8, 2009                                  DECEMBER 5 - 6, 2009                            I DATES/TIMES
                SESSION 1                                    SESSION 2 (Prerequisite Session 1)                  November 7 - 8, 2009                          Session 1 of 2         December 5 - 6, 2009                          Session 2 of 2
KT1 FUNDAMENTALS OF Kinesio Taping®                     KT3 ADVANCED Kinesio Taping®                             Saturday       8:00 am-6:00 pm                                       Saturday       1:00 pm-7:00 pm
                                                        (Total hours: 4)                                         Sunday         8:00 am-3:00 pm                                       Sunday         8:00 am-2:00 pm
(Total hours: 8)
                                                        • Clinical Concepts & Lab: Shoulder                      CE hours applied for: 16 (NJ & select states)                        CE hours applied for: 12 (NJ & select states)
Introduction to Kinesio Taping® Concepts
                                                          Impingement, Whiplash / Cervical Pain,                 (KT1 & KT2)                                                          (KT3 - KT of Dysfunctional Movement Patterns)
• Quantities of Kinesio Tape, Differences, Benefits
                                                                                                                 I FEES                                                         I REGISTRATION I LOCATION
  & Finger Demonstration                                  Chondromalacia Patella, Manual Fascial
• Introduction to Five Major Physiological Effects        & Basket Weave
  & Skin Function, Circulatory Function                 • Introduction to Kinesio Scar Tapings                   If Paying by Check (separate checks required) • MAIL                                     Days Hotel &
• KT Skin & Fascia Function                             • Scar Management “Directional Pull Application”         Tuition Fees: Payable to NUHS / Lincoln College. Send completed registration             Conference Center
• Sacrospinalis Demonstration                           • Scar Management “Pitting Scars Application”            *Supply Fee: Payable to Kinesio USA.             form and payment to:
                                                                                                                                                                                  NUHS / Lincoln College 195 Highway 18
                                                                                                                 K Session 1
• KT Muscle Function & Basic                            • Scar Management Lab
                                                                                                                                                                                  200 East Roosevelt Road East Brunswick, NJ 08816
  Application Concepts                                  • Contraindications & Precautions, Application
                                                                                                                 $325 + $125* paid by                                             Lombard, IL 60148       (732) 828-6900
• Joint Function                                          Requests, Q&A
                                                                                                                               October 23, 2009.                                • FAX
• Biotensegrity                                                                                                                                                                     630/889-6482                                    http://netopiadesigncenter.com/rama
• Application Basics, Prep, Precautions
                                                        KT of Dysfunctional Movement Patterns                    $375 + $150* paid within 14 days of session.
                                                                                                                                                                                • TELEPHONE                                         dabrunswick/home/
• Introduction to KT Assessment Tests                   - Upper Extremity (Total hours: 4)                                    ($595 at door)
• KT Assessment & Lab:                                                                                           $225 + $125* Full-time student fee. (fax ID)
                                                        • Overview & Assessment of
                                                                                                                    *Cost of supplies (one time payment)
                                                                                                                 K Session 2 (Prerequisite Session 1)
  Cervical Flexion, Cervical Extension,                   Dysfunctional Movement Patterns                                                                                                    Please bring a portable table, scissors, shorts
  Scalenes Anterior, Quadriceps Femoris,                • Treatment of Upper Extremity Dysfunctional                                                                                               and a tank top to both sessions.
  Pec Major, Rhomboid, Gluteus Medius,                    Movement Patterns with myofascial release              $325 paid by November 20, 2009.                                                                       I M P O R TA N T
  Gastrocnemius, Soleus, Deltoid,                         techniques, Kinesio Taping and therapeutic exercises   $375 paid within 14 days of session.                           Every attempt is made to offer this program as publicized. However, NUHS / Lincoln College reserves
                                                                                                                                                                                the right to adjust program dates, location, times, topic(s), faculty, tuition, etc. in order to accommo-
  Wrist Extensors & Pollicis Longus                     • Upper Cross Syndrome                                   $225 Full-time student fee (fax ID).                           date for unexpected occurrences and to cancel due to insufficient enrollment. We will only notify
                                                                                                                                                                                advanced registrants of any cancellation or program changes. NUHS/Lincoln College is not responsible
                                                        • Scapula Thoracic Rhythm & Shoulder                                                                                    for any expenses incurred by registrants due to adjustments or cancellations. A $35 processing fee will
KT2 ADVANCED Kinesio Taping®                              Impingement Syndrome
                                                                                                                 Both Sessions (1&2) paid by Oct. 23, 2009                      be charged for any tuition refund when the registrant provides written notice of cancellation at least
                                                                                                                                                                                (1) business day prior to the program date. After a program has been conducted as scheduled but the
CORRECTIVE TECHNIQUES                                                                                            $600++ + $125* ($700 + $150* after Oct. 23, 2009)              registrant did not attend nor provide a cancellation notice, tuition is non-refundable. A credit voucher
                                                        • Assessment & Treatment of the Elbow & Wrist/Hand                                                                      may be requested within 30 days of the scheduled program date and can be applied toward another
                                                                                                                 $395 + $125* Full-time student fees. (fax ID)                  NUHS/Lincoln College program. All credit vouchers must be redeemed within 1 year of the scheduled
(Total hours: 8)                                                                                                 ++$75 tuition discount – current ANJC members
                                                                                                                                                                                program date or they will be forfeited. NUHS makes no representation either directly or indirectly that
                                                        KT of Dysfunctional Movement Patterns                                                                                   the substantive matter being presented is approved or within respective scope of licensing.
Corrective Kinesio Taping® Techniques
•   Mechanical Correction                               - Lower Extremity (Total hours: 4)
•   Fascia Correction                                   • Treatment of Lower Extremity Dysfunctional
                                                          Movement Patterns with myofascial release              Name (Please Print Neatly)                                                                                          Degree(s)/Specialty
•   Space Correction
                                                          techniques, Kinesio Taping & therapeutic exercises
•   Ligament/Tendon Correction
                                                        • Lower Cross Syndrome                                   Address
•   Functional Correction
                                                        • Layer Syndrome
•   Lymphatic Correction
                                                        • Lumbar-Pelvic Rhythm Assessment & Kinesio-Taping       City                                                                             State                                                        Zip
•   Precautions, Contraindications & Rules
                                                        • Assessment & treatment of Hip, Knee & Foot/Ankle

                                                                                                                 Phone #                                          Fax #

                                                                                                                 E-mail Address (mandatory)                                                       Professional License# (primary)                              State
Vince DeBono, DC, CSCS, CKTI                            David Parish, DC, CSCS, DACBSP, CKTI
                    • Certified Strength and                                • Certified Strength and             *STUDENTS ONLY
                      Conditioning Specialist                                 Conditioning Specialist                               College/University currently attending                                                      Major/Degree Program
                                                                                                                 K Check to exclude from future e-mail program announcements.
                    • Certified Kinesio                                     • Diplomate, American
                      Taping® Instructor                                      Board of Chiropractic                     PAYMENT OPTIONS                       I AmEx. I Discover I MasterCard I Visa
                    • Vice President of
                                                                              Sports Physicians                            PLEASE CHECK ONE                   I Checks Please make tuition check payable to NUHS / Lincoln College.
                                                                                                                                                                                Please make supply check payable to Kinesio USA.
                      Academics, NUHS                                       • Certified Kinesio
                                                                              Taping® Instructor
                                                                            • Dean of Clinics, NUHS                 Account Number                                                                                  Exp. Date                    Security Code

CERTIFICATION: After successful completion of sessions 1 & 2, licensed professionals can register to                Print - Name as it appears on the credit card (must be exact)
                                                                                                                                                                                                                                                      Amount Paid
become a Certified Kinesio Tape Practitioner through Kinesio USA. Registration allows the licensed
professional to utilize the designation ‘CKTP’. Additional Kinesio® USA fee applies.                                Signature

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