2016 Bounce back conference registration

To pay securely online by Credit/Debit or Paypal, click  buy now to complete purchase. then fill out online registration form below for each paid attendee.

If paying by check
please download 2016 registration form
for each attendee at the bottom of page
and mail in with your payment.

 

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Name(required)

Address(required)

Email(required)

Phone Number(required)

Organization Affiliation (if applicable, i.e., name of school, hospital, agency, practice)

Type of Business/Organization (if applicable, i.e., education, healthcare, mental health, etc.)

Morning Sessions (11:00-12:00) CLICK ON FIELD BELOW TO MAKE CHOICE(required)

Select an option Addictions From a Frontline Perspective: Ndidia Bryant-Muslim, MHS, LCADC & Sylvia James, AS, CADC Laughter Yoga: Beverly Burns, M.Ed., CLYT Storytelling as a Healing Strategy: Charles Fleisher, Author, Motivational Speaker

afternoon Sessions (2:00-3:00) CLICK ON FIELD BELOW TO MAKE CHOICE.(required)

Select an option Journaling as a Tool for Managing Grief: Lo Anne Mayer, BS, Author The Power of Pets: Bernice Garfield-Szita, MS, LPC, TEP & Bob Szita, MS, LPC, TEP Understanding and Supporting Children and Grief: Lynn Snyder, MPS, LPC, ATR-BC, CT

How did you hear about the conference?

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  download registration form below.

BOUNCE BACK
2016 REGISTRATION FORM