Intensive Trauma Therapy

Home

About ITT

REGISTRATION FORM
Treating Traumatic Stress and Dissociative Disorders Conference:
“PTSD & The Adverse Effects of Medical and Surgical Procedures”
April 8-9, 2010

Registration Deadline: March 26, 2010

Program fees include materials, breaks, and continuing education credits. A late fee of $15 will be assessed for registrations received after March 20, 2010.

Item

Select Full Conference or Single Days

PROFESSIONALS

Full Conference (Professional Rate)

Select	Price	SubTtl	Clear

Single Day (Professional Rate)
Thursday, April 8, 2010

Select	Price	SubTtl	Clear

Single Day (Professional Rate)
Friday, April 9, 2010

Select	Price	SubTtl	Clear

STUDENTS

Full Conference (Student Rate)

Select	Price	SubTtl	Clear

Single Day (Student Rate)
Thursday, April 8, 2010

Select	Price	SubTtl	Clear

Single Day (Student Rate)
Friday, April 9, 2010

Select	Price	SubTtl	Clear

STOP!!
You must click on CALCULATE
BEFORE SUBMITTING YOUR ORDER

Total:

First Name:
Last Name:
Address:
City:
State:
Zip:
Day Time Phone:
Fax:
Email Address:

Place of Employment:
Job Title:
Licensure or Degree(s):
Type of CE's needed:
PLEASE CHECK IF
This is your first time attending this conference:	Yes No
You require assistance with hearing, vision, or mobility to make this program accessible to you, please check this paragraph and contact Marguerite Eddy at ITT (304-291-2912) prior to March 20, 2010	Yes No

press button only once, it may take up to a minute for the form to process