OPTA 2016 ANNUAL CONFERENCE - MARCH 12, 2016 HOLIDAY INN PORTLAND AIRPORT JOIN US FOR AN EXCITING WEEKEND OF EDUCATION AND NETWORKING WITH YOUR ...
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OPTA 2016 Annual Conference
March 12, 2016
Holiday inn portland airport
Join us for an exciting weekend of education
and networking with your colleagues from
across the region. You won’t want to miss it!
Photos Courtesy of Travel Portland
www.opta.org
Oregon Physical Therapy Association
2016 Annual Conference
Saturday, March 12, 2016 • Holiday Inn Portland Airport • Portland, Oregon
Conference Schedule & Course Descriptions*
SATURDAY, MARCH 12, 2016
8:00 – 8:30 AM
Registration, Continental Breakfast, Exhibits & Poster Presentation
8:30 – 9:30 AM
Opening Keynote – 1 CE Hour
Choosing to Change the World
Presented by Michael Bowers, APTA Chief Executive Officer
The APTA has established the vision for the profession of “transforming society by optimizing movement to improve the human experience.”
Physical therapists and physical therapist assistants change the world every day in their interactions with those in their care. Collectively,
the impact of the profession is profound. In this talk, we will explore how individual physical therapy professionals can prepare themselves
for greater leadership and service, how collectively we can embody the vision, and how through collaborative action transformation can
occur. We will consider how to embody the vision for the profession to transform society, from individual interaction and relationship, to
effective advocacy.
9:30 – 10:00 AM
Break, Exhibits & Poster Presentations
10:00 – 11:00 AM
Breakout Sessions A (Please Choose One) – 1 CE Hour
A1 Stop Taking Deep Breaths. Crucial Concepts for Valuable Breath Instructions.
Presented by David Deppeler, PT, DSc
Over breathing is more prevalent in our society than once thought. This presentation will include modules
ranging from a history of the importance of breathing to recognizing what a good breath looks like to
demonstrating ways to breath correctly. The presentation will also cover the Nijmegen Questionnaire and a
Self-Evaluation of Breathing Questionnaire.
A2 The Evaluation and Management of Temporomandibular Disorders (TND):
Part 1 – An Introduction to Pathoanatomy, Kinematics, and Region Specific Pain Science
Presented by Stephen M. Shaffer, PT, ScD, FAAOMPT
This session will review clinically relevant highlights pertaining to the temporomandibular joint and associated
disorders. Content areas will include basic anatomy, pathoanatomy, arthro- and osteokinematics, and region
specific pain science. There will be an emphasis on research informed content whenever possible with a focus
on clinically relevant information. By the end of this session, participants should be sufficiently aware of the
material to facilitate an improved understanding of the evaluation, diagnosis, and conservative management of
temporomandibular disorders (TMD).
Conference Color Key
Track Color
Reimbursement, Research, Reasoning & General Topics
Ortho Upper
Ortho Lower
Pediatrics
A3 Returning Runners To Training: Coaching Implications For Therapists Beyond The 10%
Rule – Part 1
Presented by Daniel B. Love, PT, DPT
Running injuries are among the most common sports injuries seen in Physical Therapy. In a classic review
article, van Gent et al. demonstrated a 19.4 to 79.3% incidence of lower extremity running injuries. Most
of these injuries are soft tissue in nature and can be treated in Physical Therapy with a successful return to
training. Much research and continuing education focuses on the evaluation and treatment of runners and has
been successful in helping many therapists become comfortable in working with this population.
Presentation to include: epidemiology/etiology review of running injuries, basic running anatomy and
physiology review, brief history of running coaching philosophies, sample running plans for 5k to marathon
distances.
A4 Resistance Exercise Training For Children Of All Abilities
Presented by Barbara Johnson, PT, MSPH, PhD
The objectives of the presentation are to increase awareness of resistive exercise training in pediatric physical
therapy, to increase knowledge of guidelines for resistive exercise training for children, to describe expected
outcomes, and provide an example of translation of knowledge to clinical practice.
11:00 – 11:15 AM
Break
11:15 AM – 12:15 PM
Breakout Sessions B (Please Choose One) – 1 CE Hour
B1 Clinical Reasoning For Physical Therapists
Presented by Cindy Zablotny, PT, DPT, NCS
Marcey Keefer Hutchison, PT, DPT, SCS, ATC, CMP
This session is designed for the therapist who is interested in integrating the principles of clinical reasoning
into their everyday practice. The presentation takes participants from theory to practice addressing the
physical therapist from entry level practitioner to advanced clinician. The presentation begins by examining the
cognitive and affective traits that are necessary for clinical reasoning. The dual process theory of cognition is
explored as a means of reconciling analytic and nonanalytic thinking. This area of the presentation broaches
the difficult topics of heuristics and pattern recognition and how reliance on these affective strategies can
result in diagnostic and procedural error. Analytic modes of reasoning are paralleled and proposed as methods
of reasoning which rely on logic and analysis to minimize error. Self-reflection is discussed and placed within
the framework of the American Physical Therapy Association’s patient management model of care as well as
the ICF. Participants engage in small group discussion and write their own self-reflection script to be used
as a prompt for future clinical reasoning. Cognitive dispositions (bias) is examined and clinical examples
highlight various forms of bias. Case-based reasoning is designed to help participants understand when bias
is occurring and resulting in diagnostic and other procedural errors. The culmination of the presentation places
theory and practice into the arena of advanced clinical decision making with case studies to coalesce the
topics which have been explored.
B2 The Evaluation and Management of Temporomandibular Disorders (TND):
Part 2 – Conservative, Musculoskeletal Examination, Diagnosis, and Management Techniques
Presented by Stephen M. Shaffer, PT, ScD, FAAOMPT
This presentation will review clinically relevant highlights pertaining to conservative, musculoskeletal
examination, diagnosis, and management techniques pertaining to the temporomandibular joint and
associated disorders. This will involve the presentation of a template that can be utilized to guide both
examination and management for those clinicians not currently comfortable or confident doing so as well as
a review of relevant diagnostic criteria. There will be an emphasis placed on peer-reviewed content whenever
possible with a focus on clinically-relevant information. By the end of this session, participants should be
knowledgeable in how to perform basic examination, management techniques for temporomandibular
disorders, and begin the process of incorporating this skill set into their clinical practice.
B3 Returning Runners To Training: Coaching Implications For Therapists Beyond The 10%
Rule – Part 2
Presented by Daniel B. Love, PT, DPT
Returning to full training is often the final goal of most runners; however, runners often do not receive guidance
from physicians, therapists, or coaches on how to return to running to optimize recovery, prevent re-injury, and
maximize performance. A basic understanding of traditional and modern coaching can help therapists guide
their patients to a safe and timely return to running and help therapists successfully and comprehensively
complete the treatment of a running population.
Presentation to include: updates on injury prevention research in runners, updates on performance
enhancement research in runners, basic coaching program design, Monday morning takeaways, and question
and answer session.
B4 Mindfulness Toward Responsive Plan Of Care Development In Pediatric PT
Presented by Ryan Jacobson, PT, DPT, PCS
The Pediatric Section of the American Physical Therapy Association has identified dosing in pediatric PT as a
priority area for advancing research, and that call to action explicitly recognizes the importance of child and
family engagement. (Kolobe, et al.) Pediatric PTs have limited published evidence to guide Plan of Care (POC)
development, and our systems within which we work are often a constraint with regards to the complex POC
decision making required to meet a child/family’s changing needs.
The purpose of this presentation is to invite and empower pediatric PTs to create more customized, responsive
POCs in their own practice, toward the end of affecting positive whole-life outcomes for the children and
families we serve. The session is intended to be engaging and interactive, offering opportunities for active
discussion and deliberate self-reflection. The perspective offered here will challenge the attendee and
presenter alike to wrestle with our perceptions and practices in light of current theory and limited evidence.
Attendees will:
• Consider potential determinants of meaningful whole-life outcomes for families of children with special
needs
• Describe the concepts of readiness & critical periods in the context of motor control / motor learning
theory
• Receive and appraise a summary table of recent evidence on pediatric PT treatment dosing
• Identify one concrete action toward more customized, responsive Plan of Care development that can be
reasonably implemented immediately in their own practice
12:15 – 1:30 PM
Lunch, Business Meeting & Networking
1:30 – 2:30 PM
General Session – 1 Ce Hour
Set Up to Fail? Proving the Value of a PT in a Fee-For-Performance Industry
Presented by Jerry Henderson, PT
In today’s fee-for-performance healthcare environment, physical therapists are set up to fail. While primary-care doctors and physicians are
increasingly being paid for the highly specified quality of their treatments, PTs are still unable to financially take advantage of the switch to
value-based reimbursement models. Why? Because physical therapists do not have a way to describe and classify their work in returning
people to full function, which is their core value. Instead, current diagnostic and procedural codes describe disease and injury care. In other
words, the diagnostic coding system does not speak the language of PT: functional movement and improvement.
Henderson, believes that the outpatient rehabilitation industry must standardize its reporting around performance-based patient tests that
demonstrate true functional progress. To date, this type of data has not been embraced by the PT industry because it was not needed in an
industry based in fee-for-service reimbursement models.
This presentation will:
• Identify the underlying problems with fee-for-service codes
• Provide solutions and standards for implementing functional-based testing and outcomes reporting Guide practices to transition to
value-based reimbursement models and receive complete reimbursement for the valuable services they provide
2:30 – 3:00 PM
Break & Door Prizes in Exhibit Area
3:00 – 4:00 PM
Breakout Sessions C (Please Choose One) – 1 CE Hour
C1 A Pragmatic Approach to Finding, Understanding, and Applying Research to Clinical Practice
Presented by Erik P. Meira, PT, DPT, SCS, CSCS
The profession of physical therapy has a history of using evaluation approaches and interventions that have
not been validated by research. As the profession embraces evidence-based practice, many clinicians have
a difficult time wading through the sheer volume of research, differentiating between higher and lower quality
research, and knowing how to apply that to their practice. Evidence and its varied levels can be manipulated
to support many different biases. Experience of the provider combined with cherry-picking evidence through
confirmation bias can bring the physical therapist far from the ideal of evidence-based practice. This session
will address these issues while exploring the inherent nature of scientific exploration of ideas.
C2 Contemporary Strategies in Assessment and Management of Musicians with Playing
Related Upper Quarter Injuries – Part 1
Presented by Carlee Uhrich, PT, COMT
The purpose of this two-part workshop introduction is to educate clinicians and students about playing related
musculoskeletal disorders as they relate to the cervical spine, shoulder and thoracic outlet. Musicians sustain
high rates of injuries compared to individuals who work in other industries that involve repetitive movements
over long periods of time. They often do not seek medical attention, and when they do, they have a low rate
of symptom resolution. Clinicians who work with musicians should be aware of specific demands related
to practice and performance in the same way sports medicine therapists have knowledge of the specific
demands of sport.
This session focuses on string instrumentalists, as they have the highest rate of documented injuries. Students
will learn to recognize risk factors, including both intrinsic and extrinsic, and how these risk factors can be
minimized when possible. Each instrument has specific postural demands and these demands may lead to
dysfunction and/or injury. Instruction will include practice with observation and evaluation techniques related
to musicians’ upper quadrant motor control, both with the instrument as well as away from the instrument.
The student will learn how to develop appropriate interventions, including self-management techniques and
exercises to address specific deficits.
C3 Lower Quarter Functional and Return To Sport Testing: Advancing Beyond Hop Testing
Presented by Nicholas Hagen, PT, DPT, SCS, CSCS, USA-W1
Recent data has shown hop testing and isokinetic testing continue to serve as gold standards in lower quarter
return to sport analysis. However, poor rates of return to play associated with injury recurrence have shown
there is more to determining readiness for a safe return to sport. The purpose of this educational session is
to familiarize the clinician with an array of lower quarter functional testing activities that go beyond the classic
measurements for strength and power. We will review testing activities for balance, strength, power, and
endurance, as well as screening tools for quality of movement. The audience will leave with a progressive
criterion-based testing algorithm that assesses the complete lower quarter function of the athlete. An in-depth
review of the literature with a focus on validity and reliability of current testing measures will be described.
C4 Adolescent Idiopathic Scoliosis: New Concepts in Conservative Management
Presented by Lisa M. Flexner DPT, DMT, CSCS, FAAOMPT
Physical therapy has not historically been used to manage idiopathic scoliosis, and families express frustration
with the classic “wait-and-see” approach. New research and approaches may help fill the gap between
diagnosis and surgical intervention, as well as limiting or preventing curve progression in some patients.
This talk will cover the epidemiology and pathomechanics of idiopathic scoliosis as we currently understand
them. It will then explore new evidence-based approaches to management, including updates on bracing and
scoliosis-specific exercise such as the Schroth method.
4:00 – 4:15 PM
Break
4:15 – 5:15 PM
Breakout Sessions D (Please Choose One) – 1 CE Hour
D1 Platform Presentations
Moderated By Sarah H. Stuhr, PT, DPT, FAAOMPT
This session will give you a chance to hear local authors share platforms outlining recent cases. There will
be time for questions between each speaker. This is a great opportunity to expose yourself to a different
perspective on a patient case, and potentially gain a few clinical pearls from some local experts.
D2 Contemporary Strategies in Assessment and Management of Musicians with Playing
Related Upper Quarter Injuries – Part 2
Presented by Carlee Uhrich, PT, COMT
The purpose of this course is to educate clinicians and students about playing related musculoskeletal
disorders as they relate to the cervical spine, shoulder and thoracic outlet. Musicians sustain high rates of
injuries compared to individuals who work in other industries that involve repetitive movements over long
periods of time. They often do not seek medical attention, and when they do, they have a low rate of symptom
resolution. Clinicians who work with musicians should be aware of specific demands related to practice and
performance in the same way sports medicine therapists have knowledge of the specific demands of sport.
This session focuses on string instrumentalists, as they have the highest rate of documented injuries. Students
will learn to recognize risk factors, including both intrinsic and extrinsic, and how these risk factors can be
minimized when possible. Each instrument has specific postural demands and these demands may lead to
dysfunction and/or injury. Instruction will include practice with observation and evaluation techniques related
to musicians’ upper quadrant motor control, both with the instrument as well as away from the instrument.
The student will learn how to develop appropriate interventions, including self-management techniques and
exercises to address specific deficits.
D3 Conservative Management of Hip Pathologies Including Hip Osteoarthritis, Fai and Labral
Tears with Special Focus on Patient Education in Home Manual Therapy and Therapeutic Exercise
Presented by Tony Rocklin PT, DPT, COMT
There are millions of individuals suffering from some amount of pain and personal disability related to hip
osteoarthritis, FAI and labral tears. The dramatic increase in prevalence is related to increasing obesity
rates, aging of our populations and improved diagnostic capabilities. The majority of individuals with hip OA
who see an orthopedic surgeon are told that they have a problem, but they are not yet bad enough for hip
replacement. There is no cure so relatively few individuals are referred to physical therapy for treatment. We
know that we are not treating the arthritis but the secondary effects of the arthritis in which there are a variety
of treatments that have been proven effective to keep people moving with less pain until they are ready for
surgery. In addition, many individuals who have been diagnosed with FAI and/or labral tears are not able to
have arthroscopic surgery because they are just outside the window being a certain age and having some
amount of osteoarthritis. Surgeons know that performing arthroscopic surgery on these individuals can lead
to abnormal increase in degenerative changes prematurely resulting in THR. To make matters worse, even if
the patient is a candidate for surgery, with the rising numbers of patients who need surgery combined with
the shortage of orthopedic surgeons, there are tens of thousands of patients in the queue for months. Based
on recent literature, there are millions of individuals who are either not eligible for surgery or are 6+ years
away from surgical intervention. There is no cure for these pathologies and during the delay from diagnosis
to surgery, they are becoming inactive, worsening in their orthopedic condition and increasing their risk for
co-morbidities related to inactivity such as heart disease, obesity, cancer, diabetes, depression and addiction.
New advances in physical therapy have been proven effective for improving mobility, functional outcomes and
pain reductions. Due to insurance limitations and expenses, patients cannot have ongoing physical therapy
in the long term. They need to learn new and effective ways to perform independent home manual therapy
and therapeutic exercise without the assistance of another person. This session will focus on educating
physical therapists on new and modern methods for Conservative Management of Hip Pathologies including
Hip Osteoarthritis, FAI and Labral Tears with special focus on Patient Education in Home Manual Therapy and
Therapeutic Exercise.
D4 Applying The Clinical Practice Guideline For Torticollis To The Evaluation And Treatment
Of Children With Congenital Muscular Torticollis
Presented by Erin Bompiani, PT, DPT, PCS and Crystal Bridges, PT, DPT
Clinical practice guidelines (CPGs) are becoming commonly used documents to help inform clinicians’ about
best practice based on available evidence. They can help optimize care by serving as a framework for clinical
decision making while supporting best practice. The APTA is supporting the development of CPGs as part of
its strategic plan. This presentation will discuss methods for developing and using CPGs. The speakers will
identify evidence-based evaluation and treatment strategies for children diagnosed with congenital muscular
torticollis using the APTA Section on Pediatrics clinical practice guideline, Physical Therapy Management
of Congenital Muscular Torticollis. Current evidence since the development of the guideline will also be
discussed.
This presentation will:
• Review the incidence and etiology of congenital muscular torticollis (CMT)
• Define clinical practice guidelines (CPG) and discuss their importance to clinical practice
• Explain the methods used for developing CPGs for the APTA’s Section on Pediatrics
• Describe the methods that clinicians use for how to implement the Section on Pediatrics CPG for the
evaluation and treatment of children with CMT
• Review research that has been published since the development of the guideline
• Discuss the importance of early identification and early referral of infants with CMT and how the CPG
might be useful in providing education to referring health care providers
5:15 PM
Conference Concludes *Conference schedule/program is subject to change
General Conference Information
General Conference Information Continuing Education Credits
Conference Location OPTA CE courses and hours may be accepted by the
Holiday Inn Portland Airport Oregon Physical Therapy Licensing Board. A course
8439 NE Columbia Blvd completion certificate will be issued to registrants upon
completion of the course. Oregon licensed therapists
Portland, OR 97220
and assistants should consult Division 35 of the licensing
503.256.5000 board’s administrative rules for CE requirements and note
that there is no pre-certification of continuing education
Conference Lodging by the Oregon Physical Therapy Licensing Board.
To make reservations, call the Holiday Inn Portland Airport
directly at 503.256.5000. Rates vary based on availability OPTA Business Meeting
plus state and local taxes. Check-in time is 3:00 pm. The OPTA business meeting will be held during the lunch
Check-out time is Noon. Please check with the Holiday on Saturday, March 12, 2016. Individuals who wish only
Inn Portland Airport for their cancellation and early check to attend the business meeting (and not have lunch) can
in policies. do so by signing in at the business meeting door and
sitting in the reserved area. If you wish to attend only the
Registration Information business meeting and lunch, please register in advance.
Your Conference registration includes: Education
sessions, electronic handout materials, exhibits, Exhibits
continental breakfast, lunch, breaks, and an early bird The exhibit area will be open Saturday, March 12 from
discount option. 8:00 am – 3:00 pm. Please take advantage of the
Space is limited. Early registration is encouraged. In the opportunity to visit with vendors during the exhibit hours
event that room space becomes filled to capacity, some and learn more about the products and services they
registrants will not be able to be accommodated and will offer. Door prize drawings will take place during the 2:30
be notified. Registrations will be accepted on a first- pm break.
come, first-served basis.
OPTA Sponsors
Three easy ways to register: Thanks to our OPTA Gold Package Sponsors
Online through our website at www.opta.org. Payment • Clinicient • PT on Call
can be made with credit card. • Gatti Law • Therapeutic Associates, Inc.
Fax your completed registration form with credit card • PT Northwest
payment to: 503.253.9172 Thanks to our OPTA Silver Package Sponsor
Mail your completed registration form with check or credit • Therapists Unlimited
card payment to: OPTA, 147 SE 102nd Ave., Portland,
OR 97216 Questions?
Contact OPTA at 503.262.9247 or tollfree at 877.452.4919
Cancellation Policy or at info@opta.org
Cancellations received on or before March 4, 2016 will
receive a full refund minus a $50 administrative fee.
Cancellations received after March 4, 2016 will receive a
50% refund of their total fees. No shows and same-day
cancellations will not receive a refund.
Speaker Handout Information
In an effort to minimize paper waste, session handouts
(as provided by the speakers) will be available online
at www.opta.org approximately one week prior to the
conference. Registered attendees will be emailed
information on how to access them.
www.opta.org
147 SE 102nd Ave.
Portland, OR 97216
OPTA 2016 Annual Conference
March 12, 2016
Holiday inn portland airport
Join us for an exciting weekend of education
and networking with your colleagues from
across the region. You won’t want to miss it!
Photos Courtesy of Travel Portland
paid
prsrt std
us postage
permit #3664
portland, or
www.opta.org
2016 OPTA Annual Conference Registration Form
Please provide the following information to register: (For additional registrants, please photocopy this form.)
❏ Mr. ❏ Ms. ❏ Mrs. ❏ Dr.
First Name:__________________________________Last Name:_______________________________Designations:____________________________________
Badge First Name (if different):__________________________________________________________________________________________________________
Company/Work Facility:________________________________________________________________________________________________________________
APTA Membership Number:________________________________________________Oregon License Number:______________________________________
Mailing Address:_______________________________________________________________________________________________________________________
City: _____________________________________________________________________________________________ State:____________ Zip:________________
Business Phone:_______________________________________ Fax:_________________________________________ Email:______________________________
Special Needs:
If you have any special requirements (i.e., vegetarian diet, food allergies, handicap access, etc.) that would necessitate
advance planning on our part, please let us know here: _________________________________________________________
Liability Waiver: By registering for this conference, you waive all liability to OPTA for any injury that may occur during this conference.
Registration Information
To completely register for the OPTA Conference it is necessary to also fill out all of the steps below to process your registration.
Step 1 – Select Your Registration Category
Early Bird discounted rates end after February 19. Registration includes the courses, continental breakfast,
lunch, and breaks.
conference registration conference registration
members Registration Fee Nonmembers Registration Fee
Early† Regular Early† Regular
❏ PT Member* $199 $239 ❏ PT $269 $309
❏ PTA Member* $129 $169 ❏ PTA $179 $219
❏ Student Member* $49 $69 ❏ Student $89 $129
❏ Service Member** $179 $219 ❏ Other Healthcare $269 $309
Professional
*Member category eligibility includes any APTA member whether in Oregon or any other state.
**Members who currently serve on either an OPTA committee or the board receive this discounted rate.
†
Early registration rates end after February 19.
Saturday Lunch and Business Meeting Only Registration
Please register here if you wish to attend only the lunch on Saturday and none of the educational sessions.
❏ $35 per Person
Name(s):________________________________________________________________________________________
TOTAL AMOUNT DUE $___________
— over —
Step 2 – Select Your Breakout Sessions
Please check your breakout session choices for the conference.
Saturday, March 12
10:00 – 11:00 am
❏ A1. Stop Taking Deep Breaths. Crucial Concepts for Valuable Breath Instructions.
❏ A2. The Evaluation and Management of Temporomandibular Disorders (TND): Part 1 - An Introduction to Pathoanatomy,
Kinematics, and Region Specific Pain Science
❏ A3. Returning Runners To Training: Coaching Implications For Therapists Beyond The 10% Rule - Part 1
❏ A4. Resistance Exercise Training For Children Of All Abilities
11:15 am – 12:15 pm
❏ B1. Clinical Reasoning For Physical Therapists
❏ B2. The Evaluation and Management of Temporomandibular Disorders (TND): Part 2 - Conservative, Musculoskeletal Examination,
Diagnosis, and Management Techniques
❏ B3. Returning Runners To Training: Coaching Implications For Therapists Beyond The 10% Rule - Part 2
❏ B4. Mindfulness Toward Responsive Plan Of Care Development In Pediatric PT
3:00 – 4:00 pm
❏ C1. A Pragmatic Approach to Finding, Understanding, and Applying Research to Clinical Practice
❏ C2. Contemporary Strategies in Assessment and Management of Musicians with Playing Related Upper Quarter Injuries - Part 1
❏ C3. Lower Quarter Functional and Return To Sport Testing: Advancing Beyond Hop Testing
❏ C4. Adolescent Idiopathic Scoliosis: New Concepts in Conservative Management
4:15– 5:15 pm
❏ D1. Platform Presentations
❏ D2. Contemporary Strategies in Assessment and Management of Musicians with Playing Related Upper Quarter Injuries - Part 2
❏ D3. Conservative Management of Hip Pathologies Including Hip Osteoarthritis, Fai and Labral Tears with Special Focus on Patient
Education in Home Manual Therapy and Therapeutic Exercise
❏ D4. Applying The Clinical Practice Guideline For Torticollis To The Evaluation And Treatment Of Children With Congenital Muscular
Torticollis
Step 3 – Payment
❏ Check made payable to OPTA or ❏ Visa ❏ MasterCard ❏ AMEX ❏ Discover
If paying by credit card, please complete the following:
Card Number:__________________________________________________ Expiration Date:________________________Amount Authorized:________________
Cardholder’s Name:_____________________________________________ Cardholder’s Signature:__________________________________________________
Credit Card Billing Address: _____________________________________ City:_________________________________State:_____________ Zip:_____________
Due to credit card security policies we cannot accept registrations over the phone or via email. Please mail or fax in your completed
registration form with payment or register online at www.opta.org.
Email Address to Send Credit Card Receipt to:_____________________________________________________________________________________________
Fax to 503.253.9172 — Mail to: OPTA • 147 SE 102nd Ave. • Portland, OR 97216You can also read
