AMTA Delaware Chapter

Registration Form

 

Fibromyalgia, Demystifying the Unexplained Disorder

Nancy Porambo

www.thetherapyoption.com

12 CE’s

Saturday & Sunday August 28-29 9:00-4:30

Clayton Hall University of Delaware

100 David Hollowell Drive   Newark, DE 19716

      Conference Fees

         

Conference Fees (A.M. Coffee/Tea is included)

                          

AMTA Member                    Non-Member                

                                          $225.00                                $300.00

        

A 50% deposit is acceptable until July 30.  Full payment is due 8/20

                                           

Special Requirements

__ Sign Interpreter

__ TDD

__Wheelchair Access

Method of Payment

___ Money Order                    ___Check

(U.S. funds only payable to AMTA DE Chapter)

___ Pay Pal (What CC?) ___________________

 

Mail this form with payment to:         If there are any questions please call or e-mail

AMTA Delaware Chapter                                             Wendy Forrest

Attn: Theresa Porta                                                       302-893-0348

24 Whitaker Avenue                                                  blkgrzly@verizon.net

North East, MD 21901                                                Cancellation Policy

 

All cancellation requests must be made in writing.                                                   

The fee paid will be refunded less $30.00 if the cancellation notice is received before 15 days of the start of the class.

No refunds will be issued 15 days from the start of the class.

 

Name     ___________________________________________________________________

Address ___________________________________________________________________

              ___________________________________________________________________

 

Telephone # for questions_____________________________________________________

 

E-Mail address ___________________________________________

 

May we confirm your registration via this e-mail address? _________

 

AMTA Member Number and State______________________________________________

 

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