International Play Therapy Institute

Summer Workshop Series Registration

Early-registration required by June 4, 2018

Name______

Credentials (please check all that apply) □ LPC □LPC-S □ RPT □ RPT-S □ NCC □ LCSW □ LMFT □ LCPC □ Other

Address______

City______State______Zip______

Phone (home/cell) ______

Company name______

Email______

Confirmation of registration will be sent by e-mail

Do you have a disability for which you will require accommodation under the terms of ADA/504? Yes □ No □

Request must be on file in our office by June 4, 2018. ADA liaison: (940) 565-2656. TYY access is available through (940) 369-8652.

Note: A total of 6 hours LPC, NBCC, RPT, and .6 CEU Texas Social Work Credit may be earned per day.

Please circle your rate: / Early-registration fee (before June 4) / Late registration fee (after June 4)
Non-student June18-22
Non-student June 23 / $140 per day
$155 / $155 per day
$170
Non-UNT student (must be full-time) June 18-22
Non-UNT student (must be full time) June 23 / $100 per day
$115 / $115 per day
$130
UNT student(full/part-time) or faculty June 18-22
UNT student (full/part time) or faculty June 23 / $80 per day
$95 / $95 per day
$110

Official documentation of current full time student status must be provided by the pre-registration deadline in order to receive the student fee.

Parking

Parking at the conference is free! Please review the website for more information.

Conference Cancellation Policy

Registration cancellation refund requests should be submitted to CPT in writing. The registration fee, minus a $50 administrative fee, will be refunded only if the request is postmarked by June 4th, 2018. You may give or sell your registration to another participant, if the original registrant notifies CPT of any registration transfers to a new attendee. CPT reserves the right to cancel this conference in the event of unforeseen circumstances. If such occurs, CPT will attempt to notify registrants prior to the conference and refund all registration, workshop, and continuing education fees. In all instances, the liability of CPT is limited to refunding such fees.

CHECK THE WORKSHOPS FOR WHICH YOU ARE REGISTERING:

□Animal Assisted Play Therapy

Monday, June 18, 2018, Risë Vanfleet

□Group Play Therapy

Tuesday, June 19, 2018, Risë Vanfleet

□Challenges in Child-Centered Play Therapy

Wednesday, June 20, 2018,Garry Landreth and Dee C. Ray

□What is Theraplay?

Thursday, June 21, 2018, Gloria M. Cockerill

□Play Therapy with Toddlers and Preschoolers: What to do When They are So Young

Friday, June 22, 2018, Mary Morrison Bennett

□Supervision in Play Therapy

Saturday, June 23, 2018,Misty Solt

Lunch is provided on Saturday, June 23. If you are registering for Saturday, please choose a lunch option below.

  • Roast Beef Sandwich Box Lunch
  • Turkey Sandwich Box Lunch
  • Ham Sandwich Box Lunch
  • Veggie Sandwich Box Lunch

Total days attending ______Amount Enclosed ______

Make check payable to: University of North Texas

Charge my ( ) Visa ( ) MasterCard ( ) American Express ( ) Discover

#______

Expiration Date ______Security Code______

Signature ______

Name on card(if different from name of registrant) ______

Note: We also accept purchase orders. Please fax to ATTN: Denise Crosswhite at (940) 565-4461

Mail/Fax to:

UNT – Center for Play Therapy (Attention: Denise Crosswhite)

1155 Union Circle #310829, Denton, TX 76203-5017

Fax: (940) 565-4461

For questions, call (940) 565-3864 or email

APT Approved Provider Number 95-004