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 May 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)

If you register BEFORE APRIL 19, you may deduct $25 from either workshop,
or $50 from the Combined workshops.

                          Core Healing             Advanced               Combined  
                      May 13 & 14                   May 15 & 16                     May 13 - 16  
                 
Members of FSCH & ASCH                          ____ $285         ____ $285          ____ $495
Non-members                                                      ____ $335         ____ $335          ____ $595      
Grad Student/Intern Members                     ____ $195         ____ $195          ____ $365
Grad Student/Intern Non-Members                      ____ $245         ____ $245          ____ $465

      
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.



FSCH
The Florida Society of Clinical Hypnosis
Workshop Registration

May Workshops
May 13-16, 2010

Non-Member, Advanced, Early
Non-Member, Advanced, Early
Member, Combined, Early
Member, Combined, Early
Non-Member, Combined, Early
Non-Member, Combined, Early
Student Member, Advanced, Early
Student Member, Advanced, Early
Member, Advanced, Early
Member, Advanced, Early
Student Member Combined, Early
Student Member Combined, Early
Member, Basic, Early
Member, Basic, Early
Non-Member, Core Healing, Early
Non-Member, Core Healing, Early
Student Member, Core Healing, Early
Student Member, Core Healing, Early
Student Non-Member Advanced, Early
Student Non-Member Advanced, Early
Student Non-Member Combined, Early
Student Non-Member Combined, Early
Student Non-Member, Core Healing, Early
Student Non-Member, Core Healing, Early