|| 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

If you are returning to pay for a previously submitted registration, please go to the return for payment page.

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

For two or more people, each person registers and pays 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 :

$199 Regular Individual Registration
$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, and pay separately
for each person.

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

If the button does not work, just phone (802.865.4883) or fax (877.445.6736) us.

You will receive a confirmation and receipt within 3 days when registration and Paypal payment are received. (Includes driving directions.)

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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