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ARC Summer Intensives Online Registration
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Full Name
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Address 1
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Address 2
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City
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State
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Zip Code
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Phone (primary)
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Phone (secondary)
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Fax
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Email Address
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Type of Registration
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(some partial scholarships available)
Both Full Days: $400 ($275 repeat)
Monday Full Day Only: $250 ($175 repeat)
Monday Movie Event Only (4-7pm): $50
Tuesday Full Day Only: $225 ($175 repeat)
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I am a repeat attendee
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I am requesting CEUs for $35/day
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If requesting CEUs: License Type
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If requesting CEUs: License #
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If requesting CEUs: State of Licensure
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Total Payment Amount
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(includes session fees and CEUs, if requesting)
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I am
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Adopted Person
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Birth Parent
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Social Worker
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Psychologist
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Parent by alternative reproduction technology
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*Payment is non-refundable* Your registration will be confirmed upon receipt of payment.
A representative from PACT will call me to take payment via credit card
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