Registration Form



Workshop  ________________________   Date: __________________________



Group     _________________________  Date: __________________________



Name:     ___________________________________________________________



Address:  ___________________________________________________________



Phone:    ____________________   Fax:  ______________________________



Email:    ___________________________________________________________



Canadian Counselling Association member:  Yes _____  No _____





Payment Enclosed

(Cheque, Post-dated Cheque, Visa, Master Card, American Express)  

Registration is complete upon payment. 



Mail to:        Express Yourself Child & Family Art Therapy 
                (Please Contact Marilyn for Mailing Address)



Contact:        Marilyn Magnuson     
         
				 Phone: (403) 836-6024
				 Email: mmagnuson@shaw.ca