SPRING CONFERENCE

The Impact of Relationships
on Individual Variation

Printable Registration Form

April 17-18, 2010

Please print this form, complete it, and mail it to:
Bowen Center for the Study of the Family
Georgetown Family Center
4400 MacArthur Blvd, NW
Suite 103
Washington, DC 20007

Registrants paying by credit card may fax this form to 202-965-1765. Phone registration with credit card is available. Call 202-965-4400.

Make checks payable to The Bowen Center. Outside the US, please use a money order or credit card.

Name: _________________________________________________
Organization: ___________________________________________
Address: _______________________________________________
City, State, Zip, Country: __________________________________
Daytime Phone: _____________________
E-mail: _________________________
Credit Card: Visa / Mastercard / Discover
(Please circle appropriate card)
Credit card No: _____________________________________
Expiration Date: _____________________________________

The registration fee is refundable less a $75 administrative charge before April 1st, 2010, and is unrefundable after that date.

Spring Conference - April 17-18, 2010
Registration		$350.00
Washington Center for Psychoanalysis Member		$295.00
WCP Member code (if applicable)		_______
Bowen Center Trainee		$275.00
Full Time Student (ID Required)		$100.00
CEU or CME Certificate fee (CEUs are offered in Social Work, Counseling, Medicine and Psychology.) About CEU Credit Units		$15.00
Clinical Conference - April 16, 2010
Regular Fee		$135.00
Bowen Center Trainees		$115.00
Full-Time Students		$40.00
CEU Certificate Fee (Social Work, Counseling) About CEU Credit Units		$15.00
TOTAL		_______