Detach and mail to:
Holistic Health Center
PO Box 96
Middle Village, New York 11379
Register early to guarantee your place. We frequently fill to capacity.
Name of Workshop:_______________________________
Registrant's Name: ______________________________
Email address: ______________________________
Professional/Graduate Student - ☐ $75 ☐ Student with no CEU's - $50
CE Credits (Included in Registration Fee): ☐ APT APT Approved Provider 06-168
☐ NBCC ☐ NASW
Amount Enclosed: ________________________
Credit card payments are accepted. Please call Dr. Kristie Doheny directly at 347-255-2087 to process credit card. Return this form with payment within one week of workshop date. Last minute registrations must be done over the phone with credit card payment..