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Issues in Therapy 2008 - REGISTRATION FORM

Professional Development for Counselors/Therapists
With Dr. Susan Heitler
Friday, September 12, 2008

First Name:

Last Name:

Title or Credentials:

Address:

City:

State:

Zip Code:

Place of Employment:

Job Title:

Email Address:

Registration Fee:

$85 Early Registration (prior to July 15, 2008)

$105 Late Registration (after July 15, 2008)

$60 Student Rate for current TNU Graduate Students

Do you want 6 CEUs for $15?

Yes

Do you wish to reserve an on-site lunch (included in the price of registration)?

Yes

Your registration fee and CEU payment need to be paid 10 days after your on-line registration form is recieved to:

Graduate Psychology- Heitler Event
Trevecca Nazarene University
333 Murfreesboro Road
Nashville, TN 38210

Graduate Psychology Program

Issues in Therapy 2008 - REGISTRATION FORM