2008 Annual Conference Registration Form

REGISTRATION

May 5, 2008 The New Face of Psychotherapy III @ Sheppard Pratt Conference Center
   Directions

Name_________________________________Degree_______License#_______

Agency________________________________________

Preferred Mailing Address_______________________________

City/State/Zip_________________________________________

Daytime Phone______________________________   FAX________________________

Email_______________________________________

Fee Enclosed $___________________________   Check #______________________

Early Registration  $79 (postmarked by March 29, 2008; no exceptions)  ________

Regular Registration $99  _________

(Fees include 6 Category A/I CEUs, certificate of attendance, coffee, breakfast, refreshments, and educational materials.)

Cancellations received in writing only postmarked prior to April 21, 2008 will be honored less an administrative fee of $35.  We regret that no refunds can be made after April 21, 2008, but you may send a colleague in your place.  Group rates of five or more and a limited number of student rates with a valid ID are available for a 10% discount paid in full by March 29, 2008.  Purchase orders, invoice payments, post-dated checks and other deferred billings must be charged regular rates.  No reservations can be held without payment in full.  Please let us know of any special needs we may try to accommodate.  ADA/EOE.

Please make checks payable to BPI and mail with this registration form to:

Baltimore Psychotherapy Institute

Baltimore, MD 21211-2120