THIS IS NOT AN ONLINE REGISTRATION FORM - FOR PRINT ONLY
Printed Date: 4/18/2024 9:23:53 PM
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Seminar Title: |
4-Day: 27th Annual International Trauma Conference: Psychological Trauma: Neuroscience, Self-Identity and Therapeutic Interventions |
Seminar Date: |
Wednesday, June 1, 2016 |
Seminar Location: |
BOSTON, MA 02210 |
Seminar ID: |
45098 |
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Required (select one) |
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Single Registrations
$575.00 Full Conference (June 1-4)
$240.00 Inaugural National ARC (June 1)
$240.00 Full-Day Workshop (June 2)
$365.00 Pre-Conference and One Workshop (June 1-2)
$375.00 Main Conference (June 3-4)
$480.00 Main Conference and One Workshop (June 2-4)
Residents, Fellows In Training, Full-Time Students (letter of verification is required)
$395.00 Full Conference (June 1-4)
$175.00 Inaugural National ARC (June 1)
$175.00 Full-Day Workshop (June 2)
$225.00 Pre-Conference and One Workshop (June 1-2)
$225.00 Main Conference (June 3-4)
$315.00 Main Conference and One Workshop (June 2-4)
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________ HI, NM attendees add applicable sales and local taxes**
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________ Subtotal (Required items + sales tax)
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________ Total (Required subtotal + Optional subtotal)
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*** Registration for coordinator or military member discount must be completed online
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**** All prices are shown in US Dollars ****
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Please enter the MAIL CODE in the box below.
If you have a brochure, this code is found on the back in the box above the address block.
If you do not have a brochure, please enter 888.
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Work Phone: |
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Email Address: |
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License Number: *
(required for confirmation of registration)
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Prepayment is REQUIRED |
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Check enclosed
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Signed Purchase Order enclosed
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Credit Card Type: |
Mastercard
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Credit Card #: |
V-Code #*
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Exp Date: |
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*MC/Visa/Discover: last 3-digit # on signature panel on back of card |
*American Express: 4-digit # above account # on face of card |
Name on Card: |
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Mail or Fax to:
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PESI, P.O. Box 1000, Eau Claire, WI 54702-1000 (800) 554-9775 (fax number) |