Barbara L. Green, LCSW








 

 

Workshop Registration
MAIL REGISTRATION FORM

1. Fill in the form below.
2. Print out completed form.
3. Mail along with payment (check, money order, or credit card info) to:
Barbara Green, LCSW
53 W. Jackson Blvd.  Suite 1361
Chicago, IL 60604

If you are paying by check, make checks payable to: Barbara Green, LCSW
 
Name:
Address:
City:

State:

Zip:
Phone: (day) (eve.)
     

Partner's Information:
Name:
Address:
City:

State:

Zip:
Phone: (day) (eve.)

 

Workshop Date:
 
Payment Information:

Check

Money Order

Credit Card
Amount:
VISA: MASTERCARD:
Card #:
Exp. Date: Signature:

Referred By:

Cancellations: If you cancel eight days or more prior to the workshop you will receive a full refund minus a $100.00 administration fee. If you cancel seven days or less prior to the workshop, you may transfer your registration fees to another scheduled workshop, however, no refunds will be made. If the workshop is cancelled by the presenter, a full refund will be made.