Registration Form - Dan Hughes, Ph.D.

Clinical Training in the Psychological Treatment of Children with Trauma - Attachment Problems 2010 Training Registration Form
Please Print or Type:
Name:
Address:
City:	State:	Zip code:

Degree:

License (State):

Telephone:

Email:

Agency (if applicable):

Nature of current practice/prior experience and training:

Please select training location and level of training

Beginning Level	July 12-16, 2010	$500.00*
Intermediate Level	July 19-23, 2010	$500.00*

Beginning Level	March 3-6, 2010 Wednesday: 9:00 am - 5:00 pm Thursday & Friday: 8:00 am - 5:00 pm Saturday: 8:00 am - 1:00 pm	$475.00*
Advanced Level	June 3-5, 2010 Thursday & Friday: 8:30 am - 5:50 pm Saturday: 8:00 am - 12:00 pm	$450.00*
Beginning Level	August 4-7, 2010 Wednesday: 9:00 am - 5:00 pm Thursday & Friday: 8:00 am - 5:00 pm Saturday: 8:00 am - 1:00 pm	$475.00*
Intermediate Level	August 11-14, 2010	$475.00*

Training's begin at:
8:30 am - 4:30 pm - Monday, Tuesday,
Thursday and Friday
8:30 am - 12:30 pm - Wednesday
* Fee includes all materials, snacks and Certificate of Attendance Receive your 20% discount on
Developing Attachment: Family Therapy Examples when you register for the beginning level training.

* Fee includes all materials, snacks and Certificate of Attendance

For Colby College Participants:
Room and board is available for participants for an additional fee (to be determined). This additional fee includes five nights Sunday through Thursday, meals Monday breakfast through Friday lunch and use of the campus gym and swimming pool. Meals are very good.

Would you like to reserve a room on campus?

Remember**

Receive your 20% discount on
Developing Attachment: Family Therapy Examples when you register for the beginning level training.

For Annville, Pennsylvania Participants:
Participants are on their own for lodging and meals, however a list of local accommodations will be provided.

Amount enclosed (please circle)	$450.00**	$475.00**	$500.00**
Registration fee should be payable to: Daniel A. Hughes, Ph.D. Send completed application form and payment to: Dan Hughes, Ph.D. 417 Reigert's Lane Annville, Pennsylvania 17003
** Payment and cancellation policy: To register by using your credit card please call Monday - Friday from 7:00 am - 3:00 pm eastern time 717-867-8335. Full payment or an initial deposit of $150.00 is required at the time of registration to reserve a place. The balance is due one month prior to the beginning of the training week. Refunds, minus a $75.00 administration fee are issued up to one month prior to the training date. No refunds will be issued within a month of the training week unless another participant is able to attend minus the $75.00 fee.
Please note: Applicants should have read "Building the Bonds of Attachment, 2nd Edition," prior to attending the training program. (click on title to order this book)

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

2010 Training Registration Form

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