For Colby participants: I plan to live on campus (single rooms) Yes______ No______ Name_______________________________________________________________________________ Address_____________________________________________________________________________ ____________________________________________________________________________________ ______________________________________________________________Zip____________________ Degree_______________________________ License (state): ________________________________ Telephone___________________________________________________________________________ E-mail_______________________________________________________________________________ Agency (if applicable)_________________________________________________________________ Nature of current practice/prior experience and training:_________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Send application/registration form and payment to: Dan Hughes, Ph.D. 2020 Boltz Lane Lebanon, PA 17046 Applicants should have read Building the Bonds of Attachment, 2nd Edition,prior to attending the training program. Amount enclosed (circle): $150 $475 $500 |
Training Week in Trauma-Attachment Problems 2008 Application/Registration |
Please print or type. +Tuition is $475 (Beginning Level), $500 (Intermediate Level), $500 (Advanced Level) (all materials, snacks, and certificate of attendance included in fee). +Room and board at Colby is approximately $300 (rates not set yet). This includes five nights, Sunday through Thursday, plus meals Monday breakfast through Friday lunch, and use of the facilities, including gym and swimming pool. Meals are very good. Participants are on their own in Annville for lodging and meals. A list of available places will be provided. +Full payment or an initial deposit of $150 is required at the time of registration to reserve a place (check payable to Dan Hughes). The balance is due ONE MONTH prior to the beginning of the training week. Refunds, minus a $75 administration fee, are issued up to one month prior to the training date. No refunds will be issued within a month of the training week unless another participant is able to fill the slot (minus $75 fee). |
****Please CIRCLE the first day of the program for which you are registering: Colby: 7/14 7/21 Annville, PA: 7/30 8/6 8/13 10/22 |
*Netscape Users* THIS PAGE MAY NOT LOAD AND/OR PRINT PROPERLY You can 1. Use Internet Explorer; or 2. Try Copy/Paste to a word processor program - this sometimes works; or 3. Email Dan Hughes dhughes1060@adelp hia.net (copy/paste) and ask for a brochure. Please include your mailing address. I've attempted to fix the problem without success so far -- but will keep trying. |
