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 2008 Workshop

                    Name: __________________________________________________________

                  Degree: _________    License #: ___________________  State: ___________

                   Work or Mailing Address: ______________________________________________

                     City: ___________________________________________________________

                         State: _______    Zip Code:_______________   County:____________________

    Work Phone: _____________________   Home or Cell Phone:________________________

                     Fax: ______________________  E-Mail:______________________________
   
          Member of:   FSCH _____  or ASCH ______                         Neither ______
    (please include documentation for ASCH)
         Student (school): ___________________________________________________________
     (with letter from faculty documenting student status)

For registrations received prior to September 23, you may take an Early Bird Discount!
Subtract $25 from either the Basic or Advanced fee, or $40 from the Combined rate.
 
                 Basic              Advanced             Combined
     October 23 & 24       October 25 & 26           October 23-26

       Members of FSCH & ASCH       ____ $295    ____ $285____ $540
       Non-members                                  ____ $345    ____ $335____ $640
       Grad Student/Intern Members         ____ $220    ____ $220       ____ $430
Grad Student/Intern Non-Members  ____ $240    ____ $235        ____ $460

      
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

October Workshops
October 23 - 26, 2008

Non-Member, Advanced
Non-Member, Advanced
Member, Combined
Member, Combined
Non-Member, Combined
Non-Member, Combined
Student Member, Advanced
Student Member, Advanced
Member, Advanced
Member, Advanced
Student Member Combined
Student Member Combined
Member, Basic
Member, Basic
Non-Member, Basic
Non-Member, Basic
Student Member, Basic
Student Member, Basic
Student Non-Member Basic
Student Non-Member Basic
Student Non-Member Advanced
Student Non-Member Advanced
Student Non-Member Combined
Student Non-Member Combined