Registration Form

* Indicates required fields.
Note: You may enter either Day or Evening Phone, but must have at least one.

 
First Name:*
Last Name:*
Affiliation:
E-Mail:
Address:*
City:*
State:* Zip:*
Phone (Day):* - -
Phone (Evening): - -


Please indicate which of the following lectures you would like to attend.

For these programs, please make checks payable to 'Four Winds Foundation'
Apr. 11 A Focus on Clinical Intervenions for the Long Term Effects of Childhood Sexual Abuse:The “Traumagenic”Dynamics Model. Fee:$25.
May 8 Child Abuse Identification and Reporting. Fee:$45.


For these programs, please make checks payable to 'Four Winds Hospital'
May 2 The Arc of Eating Disorders:Co-Morbid Diagnosis Contained Within. Fee:$15.
Jun. 6 Successfully Integrating Treatment of Co-Occurring Psychiatric and Substance Abuse Disorders.Fee:$15.


To register for one of the following free events, please call 1-800-546-1754 ext. 2413.
Apr. 8 Nursing Career Day. RSVP by April 1st. Free of Charge.
May 7 National Anxiety Disorders Screening Day. Free of Charge.


Certificate of Attendance available for all programs.