Basic Workshop Registration

PRESENTED BY: Louis Damis, PhD, ABPP, FASCH, and Akira Otani, EdD, ABPH, FASCH
WHEN: June 20, 21, 22 2025
WHERE: Via ZOOM Video Workshop

Please fill out the form below to register for this workshop.

Name*

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Email*

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Address*

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City*

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State*

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Zipcode*

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Degree*

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License #*

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License State*

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Phone*

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Payment Level*

Basic Workshop - Member of FSCH - $400.00 USD

Basic Workshop - Non-Member - $475.00 USD

Basic Workshop - Graduate Students/Intern Members - $300.00 USD

Basic Workshop - Graduate Students/Intern Non-Members - $375.00 USD

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Total

$0.00 USD

PLEASE CLICK ONLY ONCE!