The 48th Annual Symposium
on Family Theory and Family Psychotherapy
Printable Registration Form
November 4-5, 2011
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: _____________________________________
Conference Fees
Registrations must be postmarked or faxed by September 20, 2011 to qualify for the early registration fee.
About CEU Credit Units
Please circle all choices.
| Symposium |
| After 9/20/11 Registration |
|
$455.00 |
| Postgraduate Program Trainee |
|
$300.00 |
| Research Seminar Participant* |
|
$350.00 |
| Social Work CEUs |
|
$20.00 |
| Counseling CEUs |
|
$20.00 |
| |
| Clinical Conference |
| Registration |
|
$135.00 |
| Postgraduate Program Trainee |
|
$115.00 |
| Full-Time Student** |
|
$40.00 |
| Part-Time Student*** |
|
$65.00 |
| Social Work CEUs |
| $15.00 |
| Counseling CEUs |
| $15.00 |
| |
| TOTAL |
| _______ |
| 
