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.
Please see Workshop Announcement for information about the hotel and workshop location. 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 October 2010 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 _____ or ASCH ______ Neither _______
Neither _______ (please include documentation for ASCH) Student (school): _________________________________________________________________
(with proof of student status)For registrations PAID BEFORE SEPTEMBER 19 only, you may deduct
$25 from either workshop, or $50 from the combined workshop tuition.
Basic Advanced Combined October 20, 21, 22 October 23 & 24 October 20-24 Members of FSCH & ASCH ____ $350 ____ $285 ____ $590
____ $350 ____ $285 ____ $590 Non-members ____ $400 ____ $335 ____ $690
____ $335 ____ $690 Grad Student/Intern Members ____ $280 ____ $230 ____ $460
____ $280 ____ $230 ____ $460 Grad Student/Intern Non-Members ____ $305 ____ $245 ____ $500
____ $245 ____ $500 The Charles and Elaine Mutter Foundation funds workshop tuitions for 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.
Registration will NOT be complete until we have received this printed form.
