Counseling Center Conference Registration

14th Annual Utah State University Counseling Center Conference

"Mindfulness-Based Cognitive Therapy" presented by Mark Lau, Ph.D.


SEND THIS FORM WITH PAYMENT TO:
USU Counseling Center
0115 Old Main Hill
Logan, UT 84322-0115
_____________________________________________

Name: _____________________________________________

Organization/Company: ________________________________

Address:____________________________________________

City: _____________________ State: ________ Zip:_________

Phone: (_______)_____________________________________

E-Mail: _____________________________________________
Confirmation will be e-mailed

Occupation: (please check one)

___ Certified Counselor ___ Social Worker
___ Marriage & Family Therapist ___ Student
___ Professional Counselor ___ Other
___ Psychologist    

Total Enclosed: $________________

 

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