Relationship theater - Interested in Attending

Interested in attending "Don’t Blame Me! Resolving Anger in Intimate Relationships", a Relationship Theater Workshop?

This workshop is presented in cooperation with the Gestalt Institute of Philadelphia.

NOTE: If you are NOT a therapist but interested in attending please download the brochure (click HERE), complete and return.

REGISTRATION FORM

Name:

Organization:

Address:

City:

State: Zipcode:

Daytime Phone:

Fax:

E-mail:

Repeat E-mail:

Highest Degree:

To receive 6 hrs. CEU certification:
Please circle one:

LCSW LSW PSY GENERIC

Completed evaluation is required to receive CEU credits.

Comments:

For more information, contact us at:

Jackie Cohen • Relationship Theater • 97 Merbrook Lane • Merion Station, PA 19066 • 610-664-5805

GTIP • 610-668-5177 • Email: adminGTIP@gmail.com