May 13, 2017 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 print off and submit a copy of your registration form with your check.
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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