PACE Place Family Immersion Workshop

Presented by Kathi Calouri, Ph. D. &
Eric Hamblen of PACE Place Inc.
For details, click on PACE Place Seminar Series - Seattle, WA May 16, 2010.

This workshop includes 2 days of interactive lecture and hands on activities on Sunday, May  16^th and Friday, May 21^st.

Each family also receives a 5-hour private consultation to be scheduled from Monday, May 16^th to Friday, May 21^st, 2010.

Registration will be completed by phone with Deb Crowell after

receipt of this online notification

Step 1:  Registrant Information

Registrant #1 Information

(*required for confirmation) 

*First Name    

*Last Name   

*Phone Number: Home 

Phone Number: Cell  

*E-Mail 

*Mailing Address

*City   *State *ZIP

Registrant #2 Information

(*required for confirmation of Registrant #2)

*First Name    

*Last Name   

*Phone Number: Home 

Phone Number: Cell  

*E-Mail 

If different from Registrant #1:

*Mailing Address 

*City    *State *ZIP

Step 2:  Payment Selection

(required for confirmation)

Cost:
    Early Bird Registration: $1200 per family when registered before April 1, 2010
    Late Registration: $1,500 per family

Credit Card (Visa/MC/Discover only)

All Credit Card information will be accepted by Deb Crowell over the phone when she calls to finalize the registration.”

Check

        Amount 

 

For those preferring to pay via check, please print this form and mail in with payment to:                                     

PACE Place, Inc.                                                     

Attn: Deb Crowell                                                       

2360 SW 170^th Ave                                                 

Beaverton, OR  97006

Step 3:  Registrant Profile

(optional)

Please tell us a little about you or your family so that we can make the seminar as effective for you as possible.

1.  About you

       Parent

       Professional (please describe)

       Both

2. About your child(ren) at home or you work with (please check all that  apply)

 1-3                  M    F

 4-6                  M    F

 7-10                M    F

            11-18              M    F

3. Are you attending this conference with:

Spouse

Alone

Other

4. Have you attended a PACE Game Day or Seminar Series in the past?

Yes

No

Note:  If you are sent to an error page, check to be sure the required fields and options have been filled out. 

The required fields are:

    1) Select your Seminar (Full Day only or Workshop Package)

    2) Registration Information: First and Last Name, Home Phone and email. 

            Only the First Registrant is required.

    3) Payment Selection: Select Check or Credit Card and fill in the needed information.

Click     to complete your registration!

Please call Deb Crowell, Office Manager at 503-356-8334 x 6# if you have any further questions about the PACE Place Family Immersion Workshop or about PACE Place, Inc.