REGISTRATION FORM
PLAY THERAPY SEMINAR
Print this form, fill in, and mail.

Please note which seminar you would like to attend. As space is limited please register early.

Seminars:
Title: Dates:
Name: Occupation:
Address: City: Prov./State:
Postal/Zip Code: Country: Email:
Ph.: Work Ph.:   Fax.:
Education/Play Therapy Experience:

 
Have you taken a seminar with me before? If so what seminar have you taken?

 
What are some of the issues and goals you want to address in the seminar that you have registered for?

 
Would you like to book individual consultation/personal/professional development time after the seminar? On what day? How many hours?

 
 
PLEASE NOTE: A $100.00 deposit is required at the time of registration. The remaining amount is due one month prior to the seminar. Space in seminar will not be confirmed until deposit has been received for each individual seminar. Please make your cheque or money order payable to Marie-José Dhaese, and send it in by mail to:

Marie-José Dhaese
846 San Malo Crescent
Parksville, British Columbia,
V9P 1S5, CANADA

CANCELLATION POLICY: Cancellation must be received by telephone and in writing one month prior to the date of the seminar or the whole amount will be forfeited. Before that date, your $100.00 deposit will be held for administrative fees.
 
Signature: Print:   Date:
 
Amount Enclosed in Cheque or Money Order:____________ (Payable to: Marie-José Dhaese)