Registration Form

Introduction to Therapeutic Assessment
December 4-5, 2009

Registration includes continental breakfast, coffee breaks, and lunch each day.

Cancellations will be accepted until Friday, November 13, 2009; after November 13, a $75 administrative fee will apply. No refunds after November 27, 2009. 
Today's Date: Monday, February 06, 2012  
   

How did you learn of this workshop?
Member Mailing      Mailing/State Psych Assoc      Newsletter      Website      Other

   

ATTENDEE  INFORMATION

Name

Type of Address Business Address       Home Address
Street Address
City, ST, Zip
Country
Phone
Fax
Email
 
  By 10/30/09 After 10/30/09
SPA/MPA Member $300.00 $350.00
Non-Member $350.00 $400.00
SPA/MPA Student $100.00 $120.00
Non-Member Student    $140.00 $160.00

PAYMENT INFORMATION

To pay by credit card, click the "Submit" button below.  A Web page will be displayed that will enable you to enter your credit card information and complete the purchase.