PLEASE NOTE: Your registration will not be processed until payment is received. Register one person per form. Form may be duplicated. Type or print name as you would like it to appear on your nametag.

Name___________________________________________________
Affiliation ________________________________________________
Address_________________________________________________
City/State/Zip ____________________________________________
Phone __________________________________________________
E-mail __________________________________________________

The University of Wyoming is committed to making this conference accessible to all individu- als.If you have a disability and require accommodations to participate in this activity,or require special dietary needs,please check here.❑If you have special dietary need,please check here.❑You will be contacted by someone from the Office of Conferences and Institutes to discuss your specific needs.

Religious Aspects of Domestic Violence Workshop
Participant Registration before 2/24/03 ..............................$50 $________
Student Registration before 2/24/03 ..................................$40 $________
Participant Registration after 2/24/03 ................................$55 $________
Student Registration after 2/24/03......................................$45 $________
Crisis Counseling Principles 4/23
Participant Registration before 4/14/03 ..............................$79 $________
Student Registration before 4/14/03 ..................................$69 $________
Participant Registration after 4/14/03 ................................$89 $________
Student Registration after 4/14/03 ....................................$79 $________
Crisis &Trauma Intervention 4/24
Participant Registration before 4/14/03 ..............................$79 $________
Student Registration before 4/14/03 ..................................$69 $________
Participant Registration after 4/14/03 ................................$89 $________
Student Registration after 4/14/03 ....................................$79 $________
Short & Long Term Intervention 4/25
Participant Registration before 4/14/03 ..............................$79 $________
Student Registration before 4/14/03 ..................................$69 $________
Participant Registration after 4/14/03 ................................$89 $________
Student Registration after 4/14/03 ....................................$79 $________
Suicide Risk Assessment and Risk Reduction:
Tactics for the Trenches
Participant Registration before 4/14/03 ..............................$79 $________
Student Registration before 4/14/03 ..................................$69 $________
Participant Registration after 4/14/03 ................................$89 $________
Student Registration after 4/14/03 ....................................$79 $________

TOTAL FEE ENCLOSED........................................................$_______

• Make checks payable to: UW/Spring Workshop Series

• Send check or money order to:

• To register by phone: 1-877-733-3618, ex.1; 307-766-2124

• For conference content information contact:

GeorgeDoherty@mail2Consultant.com (307)745-1372

You must use a VISA/MasterCard,or AMEX card. Card #________________________________________________Exp.Date ________

• Cancellations must be received in writing. Cancellations received 5 working days prior to workshop will receive a full refund.Cancellations received less than 5 working days prior to workshop will be charged a $20 processing fee.

• No refunds for no shows.