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Registration Form for PDP Online Seminars in Specialized Topics

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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:
Address:
 
City: State/Province: Postal Code:
Country:
Phone: Fax:
E-mail:
Certification Type : Certification Number:

 

Online Seminars in Specialized Topics

Topics
regular cost
consumer/ family member cost
Online Seminar: How to Give a Workshop
____$25
____$15
Online Seminar: How to Write a Journal Article
____$25
____$15
Online Seminar: Research Issues for Mental Health Consumers/Survivors
____$50
____$30
 
____$
____$
 
Total Cost for Seminars ______


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
Credit Card Account Number:
Expiration Date:
Signature of Authorized Buyer:

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

Boston University
Boston University