Event Registration, Step One

Step One - Registering For:

Trauma & Dissociation: Evaluation and Treatment - Chapel Hill

Note: $350 ($100 deposit; $325 if registered by March 27)

Online Registration for this Workshop or Training Program is a Two-Step process:

Complete the form below, then click the "Register Online" button to submit the Registration Form;
Pay Deposit Fee. After your Registration Form has been submitted, a request for Deposit Fee page will appear. Click the "Buy Now" after the payment transaction is complete, you will be notified by phone or email regarding the schedules and details of this workshop.

Registration Form

Participant Information
* - Indicates required information!

Title (Dr., Mr., Mrs., Ms., other):
* First Name:	* Last Name:
Name to appear on Nametag:
Company/Institution:
Degree:
Profession:
* Email Address:
* Daytime Phone:	Fax:
* Evening Phone:
* Mailing Address:
* City:	* State: * Zip:
County/Province:
Country:
* Indicate the Name and Date of the Workshop or Program for which you are registering:	Trauma & Dissociation: Evaluation and Treatment - Chapel Hill

Thank you for your registration. You will be contacted shortly by phone or email with more information about this workshop. Press the "Register Online" button to send this information.

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Trauma & Dissociation: Evaluation and Treatment - Chapel Hill

Registration Form

Event Registration,
Step One