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REGISTRATION FORM Please note which seminar you would like to attend. As space is limited please register early. Seminars: |
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| Title: | Dates: | |||
| Name: | Occupation: | |||
| Address: | City: | Prov./State: | ||
| Postal/Zip Code: | Country: | Email: | ||
| Ph.: | Work Ph.: | Fax.: | ||
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Education/Play Therapy Experience:
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Have you taken a seminar with me before? If so what seminar have you
taken?
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What are some of the issues and goals you want to address in the seminar
that you have registered for?
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Would you like to book individual consultation/personal/professional
development time after the seminar? On what day? How many hours?
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| PLEASE NOTE: A $100.00 deposit is required
at the time of registration. The remaining amount is due one month prior
to the seminar. Space IN seminar will not be confirmed until deposit has
been received for each individual seminar. CANCELLATION POLICY: Cancellation must be received by telephone and in writing one month prior to the date of the seminar or the whole amount will be forfeited. Before that date, your $100.00 deposit will be held for administrative fees. |
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| Signature: | Print: | Date: | ||
| Amount Enclosed in Cheque or Money Order:____________ (Payable to: Marie-José Dhaese) | ||||
| MAIL TO:
Marie-José Dhaese
846 San Malo Crescent Parksville, British Columbia, V0P 1S5, CANADA |
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