THIS IS NOT AN ONLINE REGISTRATION FORM - FOR PRINT ONLY            Printed Date: 1/23/2019 11:39:17 PM

Seminar Title:
2019 Psychopharmacology 2-Day Conference
Seminar Date:
Monday, January 28, 2019
Seminar Location:
ELLICOTT CITY, MD 21042
Seminar ID:
66889

  Required (select one)
 
$439.99 Single Registration
$399.99 2+ Group Rate: per person
$389.99 5+ Group Rate: per person
$220.00 Student
  ________ HI, NM attendees add applicable sales and local taxes**
  ________ Subtotal (Required items + sales tax)
 
  Magazine Subscription
 
$12.99 Psychotherapy Networker Magazine Subscription - 1 Year (Full Price $36.00)
 
  Optional
 
$24.99 Psychopharmacology: Straight Talk on Mental Health Medications, Third Edition
$29.99 Treating Suicidal Clients & Self-Harm Behaviors: Assessments, Worksheets & Guides for Interventions and Long-Term Care
$29.99 Cognitive Behavioral Therapy & Mindfulness Toolbox:50 Tips, Tools and Handouts for Anxiety, Stress, Depression, Personality and Mood Disorders
  ________ AL, AR, AZ, CA, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NJ,
NM, NV, NY, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY attendees add applicable sales and local taxes**
  ________ Subtotal (Magazines + Optional items + sales tax)
   
  ________ Total (Required subtotal + Optional subtotal)
  ** Tax-exempt customers please send a copy of your tax-exempt certificate.
  *** Registration for coordinator or military member discount must be completed online or by calling (800) 844-8260 during business hours.
  **** All prices are shown in US Dollars ****
 
 

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Mail or Fax to:
PESI Rehab, P.O. Box 1000, Eau Claire, WI 54702-1000      (800) 554-9775 (fax number)