Weekend Workshop Application

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Please complete the form below to register for one of our workshops.

Please Note: Because of limited size of workshops, we can only provide admission to the first 13 people who enroll. Enrollments must be completed 10 days before the workshop. There are no discounts available.

CE Credits: Unfortunately, we do not provide continuing education credits.

Cancellation Policy: In the event that a workshop is canceled due to insufficient enrollment or severe weather conditions, we will notify you via email and/or phone and your payment will be refunded.

If you cancel two weeks prior to the workshop, you will receive a 50% refund. Otherwise, if you are not able to attend the workshop, no refund or credit will be granted.

Name *

Degree/Training *

Address *

City *

State *

Zip Code *

Phone Number *

E-Mail *

How did you hear about our workshops? *

Select each workshop you would like to enroll in. Each workshop is $225 ($175 for students - please provide a copy of your ID) *

1. An Introduction to ACT: Mindfulness and Compassion in Action

2. Introduction to Cognitive Behavioral Therapy: “It’s More Than What You Think.”

3. Learning the Language of DBT

4. Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder

5. Introduction to Dialectical Behavior Therapy (DBT): Integrating DBT Skills Into Your Clinical Practice

Required

Payment

Please provide your credit card information below. We only accept visa/mastercard at this time. You can also choose to call (212) 308-7371 to provide payment. If you plan to mail in a check, please register by mail.

Payment Type *

Name on Card *

Credit Card Number *

No Dashes (e.g. 123456789)

Expiration Date *

(MM/YYYY)

Signature - Please Type Your Name in The Field Below *

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