|| Onion River Education Network || Celani

Working with Personality Disorders

The Obsessive, Histrionic and Borderline

An Object Relations perspective
One-day workshop with David Celani, Ph.D.

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Registration

Fields marked with * are required. Info will only be used for Onion River Education Network workshops.

For two or more people, each person registers individually. Specify your partner (or group) under "Comments".

Method of Payment:

Mail: Check payable to OREN
186 White Street,
South Burlington, VT 05403-5940
Fax (Credit Card) 877-445-6736
Online (Credit Card)

Workshop:

Monday, March 7, 2011 San Diego, CA
Wednesday, March 9, 2011 North Hollywood, CA
Friday, March 11, 2011 Fullerton, CA

*Last Name:
(For 2 or more registering together see Comments section below)

*First Name:

Profession:

License Number: (not required)

NASW # (for Social Workers enrolled in the NASW)

Since we are accredited by the NASW, the NASW requests that we keep track of their members who attend our workshop. This number is not required.

*Street Address:

*City:

*State:

*Zip:

Phone Number (in case of cancellation):

Email Address to send confirmation:

*Workshop Rate:

Early (10 days before workshop)	Regular
$179 Early Individual Registration	$199 Regular Individual Registration
$169 Early Registration w/2 or more	$189 Regular Registration w/2 or more

Comments:
(if 2 or more registering, name partner/s. )

Fill a separate registration form out for each person.

Press "Register" button, then wait for Paypal payment page.

If the button doesn't work, just phone (802.865.4883) or fax (877.445.6736) us.

You will receive a confirmation email within 3 days when registration and Paypal payment are received. (Includes driving directions.) If you need a receipt, please print a receipt out from the Paypal page.

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Monday, March 7, 2011                           San Diego, CA
Wednesday, March 9, 2011             North Hollywood, CA
Friday, March 11, 2011                                 Fullerton, CA

Fax: 877-445-6736