TITLE AND DATE OF EVENT YOU ARE REGISTERING FOR:
How did you hear about this event?
What is your experience with therapy and body-psychotherapy?
What are you hoping to get out of it?
Do you need Continuing Education Credits? Y N
What is your licensing body? ____________________________________________
If you prefer to pay by cc (add 5%) please call 206-910-9766 and send your form via email, otherwise please copy and print and mail with your payment to:
Body-Psychotherapy of Seattle & Seattle School of Body-Psychotherapy
2515 NE 107th Street . Seattle, Wa . 98125