2023 Play Therapy Trainings–Registration Form Full Name of Person attending the training:* First Last Email of Person Attending the Training* License/Credentials* Occupation* Agency or School* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name of Person Completing this form if different from attendee Email of Person Completing this form--if different from Person Attending the Training. (If you're registering more than one person--please add each person's name and email and which trainings they will be attending to the "Special Accommodations" box. Thank you. Play Therapy 101 Thursday July 20, 2023 (Play Therapy 101) (9:00 AM EST-4:30 PM EST) IN-PERSON *$115.00 Thursday November 9, 2023 (Play Therapy 101) (9:00 AM EST-4:30 PM EST) IN-PERSON *$115.00 6 Contact Hours In-Person (Elizabethtown, KY) C.J. Quick, LPCC-S, LMFT, RPT-SCreating an Anti-Racist Play Therapy Practice: The Environment and Attending to Clinical Themes Creating an Anti-Racist Play Therapy Practice: The Environment and Attending to Clinical Themes (Gil) (03/24/2023) (1:00 PM EST-4:00 PM EST) ZOOM *$80.00 3 Live Webinar Hours * 03/24/2023 * 1:00 PM - 4:00 PM EST Eliana Gil, PhD, RPT-S $80.00Sand Therapy Integrated with Play Therapy: Theory and Integration Sand Therapy Integrated with Play Therapy (Gil) (04/28/23, 04/29/23, & 05/05/23) (10:00 AM EST-4:00 PM EST) ZOOM *$600.00 15 Live Webinar Hours * 10:00 AM - 4:00 PM EST Eliana Gil, PhD, RPT-S **Training is 3 days--04/28/23, 04/29/23, & 05/05/23)2-4-6-8 This is How We Regulate: Play Therapy for Dysregulated Clients with Tracy Turner Bumberry Thursday May 11, 2023 (2-4-6-8 This is How We Regulate: Play Therapy for Dysregulated Clients) (9:00 AM EST-4:30 PM EST) IN-PERSON *$135.00 Thursday May 11, 2023 AND Friday May 12, 2023 (2-4-6-8 This is How We Regulate: Play Therapy for Dysregulated Clients Paired With Finding Meaning with Mandalas--2 days) (9:00 AM EST-4:30 PM EST each day) IN-PERSON *$250.00 6 Contact Hours In-Person (Elizabethtown, KY) * May 11, 2023 * Tracy Turner Bumberry, LPC, RPT-S, CASFinding Meaning with Mandalas: Mandala Creation in Play Therapy Sessions with Tracy Turner-Bumberry Friday May 12, 2023 (Finding Meaning with Mandalas: Mandala Creation in Play Therapy Sessions) (9:00 AM EST-4:30 PM EST) IN-PERSON *$135.00 Thursday May 11, 2023 AND May 12, 2023 (Finding Meaning with Mandalas: Mandala Creation in Play Therapy Sessions Paired with 2-4-6-8 This is How We Regulate) (9:00 AM EST-4:30 PM EST each day) IN-PERSON *$250.00 6 Contact Hours In-Person (Elizabethtown, KY) * May 12, 2023 * Tracy Turner-Bumberry, LPC, RPT-S, CASEngaging Families Through Play Therapy Friday June 16, 2023 (Assessing Families Through Play Therapy) (9:00 AM EST-4:30 PM EST) IN-PERSON *$125.00 6 Contact Hours In-Person (Elizabethtown, KY) * C.J. Quick, LPCC-S, LMFT, RPT-SSand Therapy for Beginners Friday July 21, 2023 (Sand Therapy for Beginners) (9:00 AM EST-4:30 PM EST) IN-PERSON *$115.00 Friday November 10, 2023 (Sand Therapy for Beginners) (9:00 AM EST-4:30 PM EST) IN-PERSON *$115.00 6 Contact Hours In-Person (Elizabethtown, KY) * C.J. Quick, LPCC-S, LMFT, RPT-SContinuing Education needed (you may choose more than one): Play Therapy Counseling Marriage and Family Therapist Psychology Social Work N/A - I'm a Student Other If other, please list here* Any special accommodations or anything else you would like us to know?Total Cost of Registration: $0.00 May we add you to our mailing list so you can be updated on other upcoming trainings and happenings at Brighter Futures Counseling?* Yes, please! No, thanks. Please read our Cancellation Policy and confirm you've read and understand.*Cancellation Policy I have read and understand the cancellation policy. 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