Registration Form for Codependents & Narcissists: Understanding the Attraction 3/21/14


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CODEPENDENTS AND NARCISSISTS:

UNDERSTANDING THE ATTRACTION

Presented by Ross Rosenberg, LCPC, CADC & CSAT Candidate

March 21. 2014

 

SEMINAR REGISTRATION FORM

DOWNLOADABLE FORM:  REGISTRATION FORM

 

PLACE:  Astoria Banquets. 1375 W Dundee Rd, Buffalo Grove, IL 60089.  Phone: (847) 392-7500

DATE:  March 21, 2014

TIME:   Registration starts at 8:00 Am. Training starts at 8:30am.  Training ends at 3:30pm

FEE:  $125   $145 after 3/14/14

NAME: (As you wish it to appear on the CEU certificate):  ________________________________

LICENSE #____________________________________________________________________

ADDRESS (Your credit card billing address)__________________________________________

____________________________________________________________________________­­

PHONE NUMBER: ______________________________________________________________

EMAIL ADDRESS: ______________________________________________________________

CREDIT CARD NUMBER (Visa, Master Card or Discover) :________________________________

EXPIRATION DATE:____________________________________________________________

To register by phone call: (847) 749-0514 ext 12

To register by fax (847) 749-2995

To register by email, send this completed form to info@AdvancedClinicalTrainers.com

ACT Final logo crAdvanced Clinical Trainers

180 N Michigan Ave #405, Chicago, IL 60601

800-734-0974

info@AdvancedClinicalTrainers.com

www.AdvancedClinicalTrainers.com

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