holding_hands.jpg


Dyadic Developmental Psychotherapy Study Days
May 1-3, 2013
Presented by:
Daniel A. Hughes, Ph.D.

qglogo.jpg
Center for Mental Health
417 Reigert’s Lane . Annville, PA 17003
Tel:  717-867-8335  Fax:  717-867-0340

Name:

 

Organization:

 

Address:

 

 

 

City:

State:

Zip:

 

Phone #                                                                           Cell Phone #

 

Email address:

 

Prior Training:

 

 

 


 

 

 

Beginning Level Training in the Psychological Treatment of Children with Trauma-Attachment Problems

 

Advanced Level Training in the Psychological Treatment of Children with Trauma-Attachment Problems

 

Dyadic Developmental Psychotherapy Certification

 

Other (please specify)



Would you like to present a topic?  If so please provide title.

 

 

Fee: TBA

 

   

 

 

 

 

holding_hands.jpg


Dyadic Developmental Psychotherapy Study Days
May 1 – 3, 2013

 

Presented by:
Daniel A. Hughes, Ph.D.

 

 

 

 

qglogo.jpg
Center for Mental Health
417 Reigert’s Lane . Annville, PA  17003
Tel:  717-867-8335  Fax:  717-867-0340


Checks should be payable to Daniel A. Hughes, Ph.D.  and mailed to the address listed below:


Daniel A. Hughes, Ph.D.

Quittie Glen Center for Mental Health

417 Reigert’s Lane . Annville, Pennsylvania 17003

 

Mail your completed form and enclose a check or money order for the full amount.  For international registration, the check must be drawn from a US bank.  If you have any questions please email cday@quittieglen.com or call 717-867-8335.   If paying by:  Visa, MasterCard or Discover you are welcome to call Monday – Friday 7:00 am – 3:00 pm eastern time call 717-867-8335 or you may email your attached registration form along with your credit card information to: cday@quittieglen.com please include the following information:

Name as it appears on the card:

 

Credit Card Number:

 

Expiration Date:

Zip Code of the billing address for the card:

 

3 Digit Security Code:

 

Cancellation and refund policy: 

To receive a refund less $25.00 service fee, notification must be made no later than April 1, 2013.    

If you wish to share a ride we will make every attempt to provide contact information of others that are flying in at around the same time.  Please email Chris Day, Office Manager at cday@quittieglen.com.  Please include the following information:

Airport:

 

Airline:

 

Flight arrival time:

 

Email:

 

Telephone number:

 

Comments:

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