WORKSHOP REGISTRATION

Peter Russell, M.A., D.C.S

“The Art of Letting Go”

 

Friday, March 16, 2007 – 9:00 am – 1:00 pm

Martha Monro, UWG, Room 105

(#07PGA8016A)

 

             Name _______________________________________________________

 

             Social Sec. No.* ________________________________________________

 

             Address _____________________________________________________

 

             City ________________________________________________________

 

             State _____________________ Zip Code ___________________________

 

             Day Phone ___________________________________________________

 

             Employer ____________________________________________________

 

* SSN is used to confirm name when you request assistance (not required)

 

Costs:

Regular                                $50

Student                                $25

CEU certificate                  $  5

 

Make checks payable to: UWG Department of Psychology

 

To register in advance, fill out this form and mail with check to:

Alan Pope, Ph.D.

Department of Psychology

University of West Georgia

Carrollton, GA  30118

 

Note: If you paid $5 for a CEU certificate for the Thursday evening keynote presentation, you do not need to pay again.  One certificate will be issued reflecting the total credit hours (.6) for both events.

 

This program is approved as a non-credit continuing professional activity for .4 continuing education units (CEUs) by the University of West Georgia.  The University of West Georgia is recognized by the National Board for Certified Counselors (NBCC) to offer continuing education for National Certified Counselors.  This program also meets criteria for continuing professional education (M.S.W., M.E.T., LPC) and core hours as recognized by the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists.