Workshop Registration

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Workshop Selection *

I am registering for the following workshops:

7/13/2023 - 7/16/2023: Healing in the Sand: Skills in Play Therapy (Early Bird Cost: $700.00/After Early Bird Cost: $775.00)

8/11/2023 - 8/13/2023: An Experiential Approach with Children and Families (Early Bird Cost: $700.00/After Early Bird Cost: $775.00)

10/19/2023: Using the Integrative Development Model of Supervision in Play Therapy Supervision (Early Bird Cost: $75.00/After Early Bird Cost: $75.00)

10/20/2023: Doing Play Therapy: Interventions for the Playroom (Early Bird Cost: $150/After Early Bird Cost: $175)

Payment Method

*If paying by credit or debit card, you will receive an email with a secure link for payment. After payment is received in full, you will be officially registered. *A 3% service charge added to all electronic payments.

Credit Card/Debit Card (If selecting this option, please check your email for a statement from JTHCC)

Check or Cash (Please mail to: Journeys Toward Healing Counseling Center, 151 Saint Andrews Court, Suite 710, Mankato, MN 56001)

Other (JTHCC Employees)

Attestation

I have read and agreed to abide by the printed cancellation policy and all other organization policies in this brochure.

Yes

No

Special Accommodations

I have a disability as recogized by ADA/504 for which I will need special accommodations. If checked, registration must be received by October 13, 2023. Please list special accommodations being requested:

Yes

No