Starbright Training Institute

Two or Three Day Training Intensives Registration Form

Please provide the following Contact Information:

IMPORTANT NOTES ON COMPLETING THE FORM:
Do NOT press "return or enter" after completing form fields to prevent sending only a partially complete form.
Instead, press "Tab" after entering information or use your mouse to click into the next field.
Press "Submit" at the end of the form only when you have completed all your entries.
If you do accidentally press "return", don't worry . . just send another completed form. Thanks!

First Name
Last Name
Middle Initial
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Click the check boxes to select any of the following Intensive(s) you wish to attend.

The cost for two-day trainings is $350.00 and for three-day trainings it is $450.00.

	October 9-10, 2010	Sand Therapy Integrated with Play Therapy: Theory and Application
	November 19-20, 2010	Play Therapy with Abused and Traumatized Children: An Integrated Approach
	December 3-5, 2010	Assessment and Treatment of Children with Problem with Sexual Behaviors (With Dr. Jen Shaw)
	2011 Trainings TBA
	2011 Trainings TBA
	2011 Trainings TBA
	2011 Trainings TBA
	WEBINAR	Play Therapy Consultation 450.00 deposit for first six sessions

Email us at starbrightinstitute@gmail.com or call 703-831-1306 with any questions.

	BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

Specializing in working with abused children and their families.

Fact:

Starbright Training Institute

Our areas of expertise include: