Annual Conference
Friday, October 1, 2010, 1:30 pm to 8:30 pm
Saturday, October 2, 2010, 8:30 am to 5:30 pm
Part 1 of 2 – Registration Information
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Please complete all required (*) fields.
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First Name*: |
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City*: |
Zip*:
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Phone (day): |
(eve)*:
(cell):
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Email*: |
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Other:
Year:
License #:
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Other:
Year:
License #:
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Other:
Registration #:
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Would you like to receive:
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In order to facilitate placement in small groups, please let us know your
experience leading a therapy group:*
less than 1 year
1-4 years
5 years or more
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Would you like a vegetarian meal?
Yes
No |
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Do you require wheelchair access?
Yes
No |
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Note: Discounted early registration fees (as shown on next page) are available only until September 10, 2010. After that date, regular registration fees apply.
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Click button above to submit your Registration and proceed to the next page to pay registration fees. By clicking the button above, you affirm that the information submitted is accurate.
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