R E G I S
T R A T I O N F O R M
Saturday Workshops
____________________________________________________________________________________ |
| Name/Degree
(please print) |
e-mail |
_____________________________________________________________________________________ |
| Address
|
Phone
(include area code) |
_____________________________________________________________________________________ |
| City,
State & ZIP |
License
Number |
TOPIC AND
DATE______________________________________________________________
TOPIC AND
DATE______________________________________________________________
TOPIC AND
DATE______________________________________________________________
TOPIC AND
DATE______________________________________________________________
|
Number of Workshops |
Saturday Workshop |
|
|
__________ |
$75
SCSCH/ASCH Member |
__________ |
__________
|
$90
Non-Members |
__________ |
__________
|
$45
Student/Intern |
__________ |
Check
payable: Southern California Society of Clinical Hypnosis
(SCSCH)
Mail to: 10921 Wilshire Blvd., Suite 504, Los Angeles, CA
90024-4001
Or Call 888-32-SCSCH to
register by phone and pay at the door.
<<
Back to Events
|
