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
