EXPLORING THE SEXUAL OFFENDER & PHYSICAL ABUSER
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SPECIAL REGISTRATION FOR 6 OR MORE REGISTERING AT THE SAME TIME
(6 or more individuals registering at the same time regardless of agency)
Registrant Name 1:
(as it appears on certificate)
Agency:
Registrant Name 2:
(as it appears on certificate)
Agency:
Registrant Name 3:
(as it appears on certificate)
Agency:
Registrant Name 4:
(as it appears on certificate)
Agency:
Registrant Name 5:
(as it appears on certificate)
Agency:
Registrant Name 6:
(as it appears on certificate)
Agency:
Registrant Name 7:
(as it appears on certificate)
Agency:
Registrant Name 8:
(as it appears on certificate)
Agency:
Registrant Name 9:
(as it appears on certificate)
Agency:
Registrant Name 10:
(as it appears on certificate)
Agency:
Each person can register individually or under one or more credit cards or checks. Please
use the GROUP option on the website registration for Pay Pal. However, each person
registering under this group rate must be included on this registration form. Use multiple
forms if more than 10 are registering. Email this form back to scott@forensicconsultation.org.
Registration fee: (this includes program
materials, continental breakfast, snacks, and
CEU certificate). Lunch is on your own.
Early* Regular
Single Registrant $180 $250
3 or more** $165
6 or more** $150 per person
* Registration received 10 days prior to
training date.
** When three or more are registering at the
same time.
- MAKE ALL CHECKS PAYABLE TO:
SCOTT A. JOHNSON
- CREDIT CARD REGISTRATIONS
PLEASE REGISTER ON WEBSITE.
Please return your registration form by May
23, 2007. **SPACE IS LIMITED!!!!!!!!
You may register by mail or online:
Scott Allen Johnson
255 West End Drive
#1201
Punta Gorda, FL. 33950
(612) 269-3628
website: www.forensicconsultation.org