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 _______






(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.






October 20, 21, 22 October 23 & 24 October 20-24
Members of FSCH & ASCH
____ $350
____ $285
____ $590

Non-members ____ $400
____ $335
____ $690
Grad Student/Intern Members
____ $280
____ $230
____ $460

Grad Student/Intern Non-Members ____ $305
____ $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.