International Play Therapy Institute

Summer Workshop Series Registration

Early-registration required by July 3, 2017

Name______

Credentials (please check all that apply) □ LPC □LPC-S □ RPT □ RPT-S □ NCC □ LCSW □ LMFT □ LCPC □ Other

Address______

City______State______Zip______

Phone (home/cell) ______

Company name______

Email______

Confirmation of registration will be sent by e-mail

Do you have a disability for which you will require accommodation under the terms of ADA/504? Yes □ No □

Request must be on file in our office by July 3, 2017. ADA liaison: (940) 565-2656. TYY access is available through (940) 369-8652.

Note: A total of 6 hours LPC, NBCC, RPT, and .6 CEU Texas Social Work Credit may be earned per day.

Please circle your rate: / Early-registration fee (before June 30) / Late registration fee (after June 30)
Non-student July 17-21
Non-student July 22 / $140 per day
$155 / $155 per day
$170
Non-UNT student (must be full-time) July 17-21
Non-UNT student (must be full time) July 22 / $100 per day
$115 / $115 per day
$130
UNT student(full/part-time) or faculty July 17-21
UNT student (full/part time) or faculty July 22 / $80 per day
$95 / $95 per day
$110

Official documentation of current full time student status must be provided by the pre-registration deadline in order to receive the student fee.

Parking

All participants who are planning to park on campus must purchase a visitor’s parking pass from UNT.In order to receive a visitor parking pass, you must create a guest account on the UNT parking services website and purchase the pass for$5 per day. To create your guest account and purchase your parking pass, click here. After following the link provided, click Purchase Permits, then follow the instructions to log into an existing guest account or create a new one.

Conference Cancellation Policy

Registration cancellation refund requests should be submitted to CPT in writing. The registration fee, minus a $50 administrative fee, will be refunded only if the request is postmarked by July 3rd, 2017. You may give or sell your registration to another participant, if the original registrant notifies CPT of any registration transfers to a new attendee. CPT reserves the right to cancel this conference in the event of unforeseen circumstances. If such occurs, CPT will attempt to notify registrants prior to the conference and refund all registration, workshop, and continuing education fees. In all instances, the liability of CPT is limited to refunding such fees.

CHECK THE WORKSHOPS FOR WHICH YOU ARE REGISTERING:

□Using Expressive Arts in Play Therapy: Trauma Informed Practice: Day 1

Monday, July 17, 2017, Cathy Malchiodi,PhD., LPAT, LPCC, ATR-BC, REAT

□Using Expressive Arts in Play Therapy: Trauma Informed Practice: Day 2

Tuesday, July 18, 2017, Cathy Malchiodi, PhD., LPAT, LPCC, ATR-BC, REAT

□Understanding the Deeper Meaning of Children’s Play – A Jungian Analytical Play Therapy Perspective.

Wednesday, July 19, 2017,John Paul Lilly, MS, LCSW, RPT-S

□Facilitating Hope and Resilience in Play Therapy with Complex Trauma.

Thursday, July 20, 2017, David A. Crenshaw, PhD., ABPP, RPT-S.

□The Ethics in Play Therapy in a Changing World (9am-12pm) and

Play Therapist Self-Care: Emotional Competence and Sanity (1pm-4:30pm).

Friday, July 21, 2017, Jeff Ashby, PhD.

□Sounds like fun!! Play Therapy with Pre-teen and Teen Clients.

Saturday, July 22, 2017,Jeff Ashby, PhD.

Lunch is provided on Saturday, July 22. If you are registering for Saturday, please choose a lunch option below.

  • Roast Beef Sandwich Box Lunch
  • Turkey Sandwich Box Lunch
  • Ham Sandwich Box Lunch
  • Veggie Sandwich Box Lunch

Total days attending ______Amount Enclosed ______

Make check payable to: University of North Texas

Charge my ( ) Visa ( ) MasterCard ( ) American Express ( ) Discover

#______

Expiration Date ______Security Code______

Signature ______

Name on card(if different from name of registrant) ______

Note: We also accept purchase orders. Please fax to ATTN: Denise Crosswhite at (940) 565-4461

Mail/Fax to:

UNT – Center for Play Therapy (Attention: Denise Crosswhite)

1155 Union Circle #310829, Denton, TX 76203-5017

Fax: (940) 565-4461

For questions, call (940) 565-3864 or email

APT Approved Provider Number 95-004