TO REGISTER FOR “Victoria Dickerson- Couples Therapy: Working with Power and Privilege - Winnipeg, November 18th and 19th 2010"

Please fill this form and mail it to Winnipeg Narrative Therapy with a payment either by mail at 82 St Albans Rd or you can pay ONLINE throught paypal

Online: http://www.winnipegnarrativetherapy.com
By Mail: 82 St Albans Rd Winnipeg Manitoba R3Y1W8

Please make cheques payable to Mariana Sussi

Your Information:

*First Name:
*Last Name:
  
Position:
  
Organization:
  
*Address:
  
*City:
  
*Province:
  
*Postal Code:
 
Home Phone: ( )
  
*Work Phone: ( )
  
*Work Fax: ( )
  
*E-mail:
  
*Workshop Title:
  

Comments:

 

 
Payment Options:
Winnipeg, November 18th and 19th 2010 - 9 am to 4:00 pm
   
Individual Registration
Group (5+) Registration
Early Bird Enrollment
  
$257.25
$245
Registration Until September 20th 2010  
       
Early Bird Student  
$183.75
$175
Registration Until September 20th 2010  
       
Regular Enrollment  
$288.75
$275
   
       
Regular Full time Student  
$204.75
$195
   

Other participant's Names: