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Program Registration

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Thank You to Our
2009 Autumn Delights
Sponsors

Semi Sweet Chocolate Sponsor

Tutorial Services, Inc.

Milk Chocolate Sponsor

Allergy and Immunology Associates
Bank of Ann Arbor
Dykema
Michigan Commerce Bank
Quantum Physical Therapy
TCF Bank

Bittersweet Chocolate Sponsor

Ann Arbor State Bank
Bredernitz, Wagner & Co. P.C.
Brust Orthodontics
Kate & Jef Fox
Liquid Manufacturing, LLC
St. Joseph Mercy Health System
Tower Inn Cafe

Annual Conference Registration

Hurt, Rage, and Emotional Maltreatment: Is There Anything We Can Do?

To register, please completely fill out the form below.

$40 Pre-Registration (by Friday, April 9, 2010)

$10 SW – CEU

$15 Student

$35 EACH Group Rate (groups of 5 or more)

SB – CEU ( $10 PAYABLE TO WISD – Paid Day of Conference ONLY)

Groups: Please list names of ALL attending. You will need to pay $35 for each + $10 for each requiring a SW – CEU.

Name (as it appears on credit card):

Address where you receive your credit card bill:

Street:

City:

State:

Zip:

Email:

Phone:

Card type (choose one):

MasterCardVisa

Card number:

Expiration date (MM/YYYY):

/

Are you a student?

Yes No

Total to be charged to your card:

$

You will receive confirmation of your registration within the next two business days.

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