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Mail-In Registration Form
The 6th Annual West Georgia
Spirituality and Psychotherapy Integration Series
TOWARDS A LARGER SELF
May 29-31, 2008
PRINT OUT FOR POSTAL REGISTRATION:
NAME: _________________________________________________________
ADDRESS: _____________________________________________________
CITY/STATE/CODE: ____________________________________________
PHONE: ___________________________________
EMAIL: ___________________________________
ORGANIZATION (if applicable) : ______________________________
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Workshop Fees
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SubTotal
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Before May 2
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ChildSpirit members,
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Non-members,
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2 or More from Same Agency
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LAPc & Full Time Students (no University Credit)
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LATE REGISTRATION, After May 2
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$300
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CEU Certificate
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$ 10
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Become of ChildSpirit Member, (see benefits and discounts on upcoming workshops at www.childspirit.org)
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$ 45
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TOTAL
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Payment
Payment may be made by check, PayPal or Credit card payment (through the PayPal gateway:) For Checks, please remit to:
ChildSpirit Institute
1601 Maple Street
c/o Department of Psychology
University of West Georgia
Carrollton, GA 30118
Refunds available until May 2, 2008 (-$50)
Graduate Students may register for this workshop as part of a larger course, Psychotherapy Spirituality Integration (Psyc 6785 01, 3 credit hours).
No additional fees or registration information is required beyond your University of West Georgia sign-up.
Sponsors and Information:
ChildSpirit Institute
Mary Hart, 678-839-0609
The Zenter
Inge Mula Myllerup Brookhuis, 770-836-1205
The Department of Psychology
University of West Georgia
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www.childspirit.org
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