REGISTRATION FORM

Continuing Education Series - Winter/Spring 2008
Sponsored by Nova Southeastern University's Center for Psychological Studies

 
Name: 
Degree: 
 
 
Address: 
 
 
City:   State:  Zip code:  Phone: 
 
 
E-mail Address:  *required
 
 
Please email me about future workshops.
 
 
Check all that apply:
  
Psychologist
 Mental Health Counselor
 Other (Specify)
School Psychologist
 Social Worker
Marriage and Family Therapist
Student
 
 
License number: 
License state: 
Certificate number: 
 
 
 
(Please specify all license numbers for documentation purposes.)
  
 
NSU CENTER FOR PSYCHOLOGICAL STUDIES (Faculty and Students only)
Check all that apply:
  
 

Full-time academic/clinical faculty
 Part-time core fculty

Full-time CPS students
CPS Alumnus

Adjunct Faculty


  
 
WORKSHOPS
Check all that apply:
  
 
Saturday, May 31 Using Motivational Interviewing Strategies and Techniques to Help Patients Change Risky/Problem Behaviors
 
 
WORKSHOP FEES*
One Day
advance registration
$ 98
on-site registration
$ 105
full-time students & faculty
free





 
 
*Make checks payable to Nova Southeastern University and mail to:
Nova Southeastern University
Center for Psychological Studies, Attn: Kym Walsh
3301 College Avenue, Fort Lauderdale, FLorida 33314-7796
Telephone:800-541-6682, ext.5790, or (954) 262 -5790
Fax: (954) 262- 3893

Note: Online payments are currently not accepted at this time.
  
 
Refund and cancellation policy
A full refund credit for another program will be issued for cancellations received no later than one week prior to the workshop date. Credit toward another program will be awarded for cancellations after that date. Credit toward another program will be awarded for cancellations after that date. The university reserves the right to cancel the program due to low registration.