Managing Bipolar Disorder Students
                                   Friday  30 November, 2007

                                                 Early        Late
Cost:  Single Registrant     $100         $110         Per Person
Two or More**                      $  90          $100         Per Person     
College Students***            $ 45           $50           Per Person

6 hours continuing education credit
*Registration must be received seven days prior to the workshop date
**Price per person when two or more register at the same time from the  
same school campus.
***Must submit a college ID with payment!

For additional information please leave a message below with your e-mail.
Send Checks or
Purchase Order to:

106 Denton Tap Rd.,
Ste 210-216
Coppell, Texas

Only Checks and
Purchase Orders are
accepted. P.O.'s may
be faxed to:  
                   Managing Bipolar Disorder Students

Print this page from your web browser to obtain a registration form!

Comfort Inn DFW North  Irving, TX    Friday   30 November, 2007
(972) 929-5757 or Toll Free Number: 1-800-4-CHOICE

_____________________________       _____________________________
Registrant's Name                                     Registrant's Name

_____________________________       _____________________________
Registrant's Name                                     Registrant's Name

Total Cost: ____________   

Method of Payment Accepted

Check or Money Order
Purchase Order #:______________________________
Credit Card:  Must have the credit card number with expiration date
, the three letter code on
the back of your card, your name as shown on your card and your billing address.

Credit Card Type: ______ Number_______
___________Code:______Expiration Date:_____

Name as shown on card:_____________________________

Mailing Address:_____________________________________________________________
                                                                                       City                        State   Zip
Phone Number:________________________________



If you prefer you may call and give us your credit card information.   972-506-7111

Mail this form with Payment
or PO to:
106 N. Denton Tap Rd., Ste 210-216
Coppell, Texas  75019