Registration Form
Please copy and paste this information into an email or word document and send to Joan@RelationshipTherapy.net.
Payment options below.
Location/date of workshop(s) you will attend:
TBA Charleston, SC (Sexual Pharmacology) ________ Lunch Reservation______
April 26-27 Charleston, SC (Sexual A/P and Medical Factors) ________
April 28 Charleston, SC (SAR) ________
Nov 29-30 Charleston, SC (Sexual A/P and Medical Factors) ________
Dec 1 Charleston, SC (SAR) ________
Name as you want in on the certificate:
Academic degree(s)- BS, MSW, PhD, etc:
Mailing address:
Cell phone:
Home or work number:
Preferred email (if using work email, please include a personal one as well):
Are you an AASECT member? (not required to attend)
Are you working on certification or considering it?
Brief description of your practice or educational setting.
Are there any special interest areas in the sexuality field?
Are you interested in a room share if there is someone else interested as well?
Preferred morning refreshment: regular coffee, decaf coffee, hot tea or none of these.
The registration fee for the Thur/Fri training is $360 and the fee for the SAR is $380. There is a $50 discount if attending both making the total $690. (FYI-The SAR at the 2011 AASECT conference was $450).
The student registration for Thur/Fri is $240 and the fee for the SAR is $250. The total for both is $490. There is no additional discount for the student rate for attending both.
The registration fee for the Sexual Pharmacology is $100 for professionals and $80 for students.
Hotel is offering lunch at $10 including the tax and tip. This includes a choice of sandwiches/salads, dessert and tea/coffee. The money will be collected at the door. Please do not include with your registration fee.
To pay by check (preferred):
Check payable to Joan Sughrue
POB 341
Sullivan’s Island, SC 29482
Payment by credit card:
Questions?
Email me- Joan@RelationshipTherapy.net or call 770-655-3082.
Looking forward to meeting you!