Borderline Personality Disorder,
Trauma, and Resiliency

Yale Conference     ▪     May 2, 2008

New Haven, CT
Registration
Secure online registration is available. Click here.

OR, print this form and complete.

 

MAIL along with check made payable to "NEA-BPD/Yale Conference" to:

P.O. Box 1627

St. Albans, VT 05478

 

FAX completed form and and credit information to (253) 540-3691

 

Full refund will be given minus a processing cost for cancellations postmarked prior to April 18, 2008 - 10 days prior to conference.

 

Name

Discipline (circle one)

MD PhD MSW LCSW APRN RN LMFT Other (specify)____________

Credit requested

□ NASW/CT
□ Certificate of Attendance

This program has been approved for 6.25 Continuing Education Credit Hours by the National Association of Social Workers, CT and meets the continuing education criteria for CT Social Work Licensure renewal.

Organization/affiliation
Address
City State Zip code
Daytime phone

E-mail
Rates
□ Professional $100

 
□ Trainee* $35 *Yale trainees, contact david.klemanski@yale.edu
□ Individual family member $50  
□ Consumer $20  

Rates include continental breakfast and lunch.
       
Payment    
Credit card type (circle one)    
  MasterCard  Visa Discover American Express
Credit card number
Expiration date (MM/YY)
Print name as it appears on card
Billing address (If same as above, please check .)

Cardholder’s signature

 

 

 

 

 

 

 

 

 

© 2005-2008 National Education Alliance for Borderline Personality Disorder

PO Box 974, Rye, New York 10580
914-835-9011

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