Wellness in Action Series  

February through April 2008  

  

Cost for the Series:          

$240 for all three parts when received before Jan 25  

$270 for all three parts when received after Feb 8 

Limited to 12 people  

  

Name:______________________________________________________________  

Mailing Address: ______________________________________________________  

____________________________________________________________________  

Phone Number: _______________________________________________________  

Email Address: ________________________________________________________  

Would you like to be on an email list for this group?   Yes     No 

Would you like to receive Dynamic Paths email newsletter?   Yes    No 

There are many organizations who provide CE for mental health professionals, what is your  

credentialing organization from whom you would like to receive credit? ____________________________________________________________________  

  

__________________________________________________________________  

How many years have you been in practice:  

1-5 yrs   6-10 yrs  11-15yrs  over 15 yrs  

Do you already talk about nutrition and physical activities with your clients?  Yes    No 

What are you hoping to gain from this series: ______________________    

____________________________________________________________________  

____________________________________________________________________  

  

For answers to questions about the series or to registration call Dr. Allott at (206) 579-2757  

  

                                                                         Dynamic Paths
Please mail this form with full payment to:   PMB 6604
                                                                         10002 Aurora Ave N. #36
                                                                         Seattle, WA 98133