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REGISTRATION FORM
PSYCHODRAMA TRAINING, 2012
Please print clearly
Name
Address
City
State Zip
Phone: ( ) (O)
( ) (H)

email:

Please check the program you wish to attend:

Week-long

Fee: $755 or $830; Deposit: $200

❏ 7:00 p.m., July 13, 2012 to 1:30 p.m., July 19, 2012

Weekend

Fee: $310 or $335; Deposit: $100

❏ 7:00 p.m., July 13, 2012 to 1:30 p.m., July 15, 2012

Pre-conference

Fee: $100 or $125

❏ 10:00 a.m. to 5:30 p.m., July 12, 2012

❏ Please put me on your mailing list. I am interested
in future programs.

Amt. Enclosed: $
Email:
I certify that I am in good health physically and mentally and that I am fully capable of participating in this training workshop. If I am in therapy, I understand that I will consult with my therapist before enrolling.

Signature
Date

SPACE IS LIMITED. PLEASE RETURN REGISTRATION FORM IMMEDIATELY.

Make checks payable to Psychodrama Training and mail to: Sue McMunn/ 926 Fair Haven Ct/ Naples, FL 34104

Cancellation Policy: Deposits fully refunded until April 13, 2012. Cancellation after April 8, 2011 will be refunded minus $50 cancellation fee. No Refunds after May13, 2011. Week-long participants must pay 50% of the tuition by May 13, 2011.

Special daily rates: Single/Double - $119.00 / Space limited. Reduced rates available for ocean front rooms and suites. Inquire now. Reserve now.
Room sharing arrangements available.
Brochure and reservation form for Hutchinson Island Marriott Resort will be sent upon receipt of deposit. Mention group to receive reduced rate.