To register, please print and fill out this form, and send it along with your check to: FSCH, at
8227 SW 82 Place, Miami, FL 33143. If you have any questions please call 305-598-9992.
If you would rather pay your tuition online, please print and send this page, but use the Paypal buttons at the bottom of this page to pay the fee. Paypal is the only way we can accept credit cards.
Registration for May 2012 Workshop
Name: _________________________________________________________________________ Degree: _________________ License #: ______________________ State: _____________ Work or Mailing Address: ________________________________________________________
City: ___________________________________________________________________________
State: _______ Zip Code:________________ Florida County:_________________________
Work Phone: _____________________ Home or Cell Phone:_________________________
Fax: ______________________ E-Mail:_____________________________________________ Member of: FSCH _____Yes _____No
Student (school): ________________________________________________________________ (with proof of student status)Registrations received before April 20, 2012
will be entitled to an Early Registration Fee, as noted below.
Early Registration Regular Registration Members of FSCH ___ $285 ____ $310 Life Members of FSCH ___ $145 ____ $155 Non-members ___ $325 ____ $350 Grad Student/Intern Members ___ $225 ____ $250 Grad Student/Intern Non-Members ___ $245 ____ $270 The Charles and Elaine Mutter Foundation funds workshop tuitions for a limited number of
student member attendees with financial needs,
up to 40% of tuition. Call Diane, at 305-598-9992, for more information.
If you'd like to join FSCH, please print and fill out the membership application on this site,
and include it along with your separate membership fee, a copy of your license,
and your workshop registration fee with this printed form.
Please send fees and appropriate documentation to:
FSCH, 8227 SW 82 Place, Miami, FL 33143
or, to pay online, using a credit card, please use the appropriate Paypal button below.
Please note: you will still have to print and fill in the above form, and send it,
along with any necessary documentation, to the above address,
or fax it to 305-598-9992.
Registration will NOT be complete until we have received this printed form.
_____________________________
To add a contribution to the Mutter Scholarship Fund, please click below:
