Online Seminars: Registration Form

Registration Form for PDP Online Seminars

return to Online Seminars web page

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	Cost
Self-Directed Psychiatric Rehabilitation Activities	____$50
Group Process Guidelines Shipping for a copy of Group Process Guidelines book	____$100 ___$8.50 inside US ___$20 outside US
Ethics in Psychiatric Rehabilitation	____$25
Research Issues for Mental Health Consumers/Survivors	____$50
How to Give a Workshop	____$25
How to Write a Journal Article	____$25
TOTAL

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