UNT Center for Play Therapy Fall Conference 2015
November 12 & 13, 2015
Early Registration Ends October 29, 2015
Name _____________________________________________________________________________
Address ___________________________________________________________________________
City ______________________________________ State _____________ Zip ___________________
Phone (home/cell) ___________________________________________________________________
Email _____________________________________________________________________________
School name/Contact person (for P.O.s) __________________________________________________
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 October 29, 2015. ADA Liaison: (940) 565-3864. TYY access is available through (940) 369-8652.
Note: A total of up to 12 contact hours may be earned through the 2-day training. The UNT Center for Play Therapy is approved by: Association for Play
Therapy, Texas State Board of Licensed Professional Counselor, National Board for Certified Counselors, Texas State Board of Social Workers, and Texas
State Board of Marriage & Family Therapists.
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 November 20th, 2015. 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.
Conference Rates
Professional – Single Day
Professional – Both Days
UNT Student – Single Day
UNT Student – Both Days
Non-UNT Student – Single Day
Non-UNT Student – Both Days
Early Registration (before Oct. 29)
$140
$250
$80
$160
$100
$200
Late Registration (after Oct. 29)
$155
$280
$95
$190
$115
$230
CHECK THE WORKSHOP DAYS YOU ARE REGISTERING FOR:
□ Art Techniques for Play Therapists
Thursday, November 12, 2015 with Terry Kottman, Ph.D., LMHC, RPT-S, NCC
□ Family Play Therapy — Adlerian Style
Friday, November 13, 2015 Terry Kottman, Ph.D., LMHC, RPT-S, NCC
□ I understand the Center for Play Therapy Conference Cancellation Policy.
BY CHECKING THE ABOVE BOX, I CONFIRM I HAVE READ AND WILL COMPLY WITH THE CENTER FOR PLAY THERAPY CONFERENCE
CANCELLATION POLICY.
Amount Enclosed ________________
Make check payable to: UNT - CPT
Charge my: □ Visa □ MasterCard
□ American Express
Card # ____________________________________________
□ Discover
Expiration Date ________________________
Signature __________________________________________
Name of Registrant (if different from person paying) ___________________________________________
Mail/Fax to:
UNT Center for Play Therapy
ATTN: Susan Enebo
1155 Union Circle #310829, Denton, TX 76203-5017
Phone: (940) 565-3864 ● Fax: (940) 565-4461 ● EMail: cpt@unt.edu