Registration Form for Internet Courses

Registration Form for PDP Internet Courses

A separate registration form must be completed and submitted for each applicant. Please fax or mail your registration form to Sue McNamara (contact information is below).

Address

Name_______________________________________________________________________________________________________

Agency_____________________________________________________________________________________________________

Street Address_______________________________________________________________________________________________

City_________________________________________________State_____________Zip Code______________________________

Country______________________________________________Email __________________________________________________

Phone________________________________________________Fax____________________________________________________

Certification Type______________________________________Certification Number______________________________________

PDP Internet Courses

Item	regular cost	consumer/family member cost
PDP 606: Rehab of Persons w/Psych Disability	____$300*	____$240*
PDP 608: Psych & Social Aspects of Psych Disability	____$300*	____$240*
PDP 703-Rec: Facilitating a Recovery Workshop	____$225*	____$180*
	Total Cost for Courses ______

*(no shipping cost, no sales tax)

Required Books

Item	regular cost	consumer/family member cost
PDP 606: Rehab of Persons w/Psych Disability
Psychiatric Rehabilitation, 2nd edition	____$79.95	____$63.96
Readings in Psychiatric Rehabilitation (on CD)	____$34.95	____$27.96
Psych & Social Aspects of Psych Disability	____$44.95	____$35.96
PDP 608: Psych & Social Aspects of Psych Dis.
Psych & Social Aspects of Psych Disability	____$44.95	____$35.96
Experience of Recovery	____$10.00	____$10.00
Anguished Voices	____$10.00	____$10.00
PDP 703-Rec: Facilitating a Recovery Workshop
Recovery Workbook	____$29.95	____$23.96
Leader's Guide: The Recovery Workbook	____$4.95	____$4.95
Experience of Recovery	____$10.00	____$10.00
Subtotal cost for required books______
MA 6.25% sales tax (only for MA residents purchasing books) ______
Shipping Costs for Books only (see chart below to determine shipping costs) ______
Total Cost for Books ______

Payment Method

( ) Enclosed is a check or money order made payable to Boston University.
(Payment must be in U.S. funds by U.S. bank draft or international money order.)

( ) Please charge my credit card: ____ VISA ____ MasterCard ____ Discover Card

Card Account Number ______________________________________________________________

Expiration Date ____________________________________________________________________

Signature of Authorized Buyer ________________________________________________________

Shipping and Handling
Order Subtotal	Within U.S.	Outside U.S.
Under $100	$8.50	$20
$100 - $500	7% of subtotal	20% of subtotal
Over $500	5% of subtotal	20% of subtotal

Send Order Form to:

Sue McNamara, MS, CRC, CPRP
Professional Development Program
Boston University
Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West
Boston, MA 02215
FAX: 617/353-9209
PHONE: 617/358-2574
e-mail: suemac@bu.edu