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 St., South Burlington, VT 05403-5940 Fax (Credit Card) 877-445-6736 Online (Credit Card)
Workshop:	Monday, October 25, 2010 Fresno, CA Wednesday, October 27, 2010 Sacramento, CA Friday, October 29, 2010 Palo Alto, CA
*Last Name: (For 2 or more registering together see Comments section below)
*First Name:
Profession:	Select Profession Social Worker/LCSW Psychologist Mental Health Counselor Licensed Professional CounselorMarriage and Family Counselor Drug & Alcohol Counselor/Addictions CounselorPsychoanalystPastoral Psychotherapist Nurse Teacher/Educator Guidance Counselor School Psychologist Student/Intern Other
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 and receipt within 3 days when registration and Paypal payment are received. (Includes driving directions.)