2008 AzAMFT REGISTRATION FORM
Phoenix Morning Breakfast Workshop

Ethics in Marriage and Family Therapy: A Review in Practice

May 2, 2008 - 8:00 AM to 12:00 PM

Presented by Dan Wright, LMFT & Steve LeGendre, LMFT

Mountain Park Community Church

2408 E. Pecos Road

Phoenix, AZ 85045

Name: _____________________________________________________

Address: __________________________________________________

___________________________________________________________

Phone: __________________ Email: __________________________

Registration Fees (Check One):

     ___ AzAMFT Member       $65.00

     ___ Non-Member          $75.00

     ___ AzAMFT Student      $35.00

     ___ Non-Member Student  $40.00

     All fees include breakfast!

___ Enclosed is a check in the amount of $ __________

     Make check payable to: AzAMFT

___ Charge my credit card # __________________________________

        ___ VISA     ___  MasterCard  (Sorry, AE not accepted)

Expiration Date: ________________

Signature: _________________________________________

Mail your completed registration form and payment to:

AzAMFT
c/o Katherine Keuth

301 E. Bethany Home Road, Suite C296

Phoenix, AZ  86012

WALK-INS WELCOME - Same fees as stated above.

THANK YOU! WE LOOK FORWARD TO YOUR PARTICIPATION!