December 16th TRE Workshop Registration
Please complete the registration form below.
Name *
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Address *
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City *
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State *
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Zip Code *
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Email *
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Phone Number *
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For clinicians only: If you would like CEUs for this workshop, please list your degree and license number (LCSW, LCPC, LMFT, Licensed Clinical Psychologist)
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Do you have any physical limitations, injuries, or currently taking any medications? *
If yes, please explain.
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How did you hear about this workshop?
How would you like to pay? *
*Please note: If paying by check please include registrant name on the check.

*If you prefer to provide your credit card info over the phone, please note so in the comments and we will call to take payment.

Credit Card Number
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Credit Card Expiration Date (mm/yy)
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CCV
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Billing Zipcode
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Notes/Comments
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If you have any questions, please contact Jennifer Rolnick at Jennifer@watchhilltherapy.com or 312-498-9715
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