Print this form, fill in, and mail.

Please note which seminar you would like to attend. As space is limited please register early.


Title: Dates:
Name: Occupation:
Address: City: Prov./State:
Postal/Zip Code: Country: Email:
Ph.: Work Ph.:   Fax.:
Education/Play Therapy Experience:


Have you taken a seminar with me before? If so what seminar have you taken?


What are some of the issues and goals you want to address in the seminar that you have registered for?


Would you like to book individual consultation/personal/professional development time after the seminar? On what day? How many hours?


Space in the seminar will not be confirmed until payment has been received for each individual seminar. Payment can be made by cheque or e-transfer to Please make your cheque or money order payable to Marie-Josť Dhaese, and send it in by mail to:

Marie-Josť Dhaese
846 San Malo Crescent
Parksville, British Columbia,

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, $100.00 will be held for administrative fees.

Signature: Print:   Date:
Amount Enclosed in Cheque or Money Order:____________ (Payable to: Marie-Josť Dhaese)