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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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. 2-4-6-8 This is How We Regulate: Play Therapy for Dysregulated Clients with Tracy Turner Bumberry 2-4-6-8 This is How We Regulate: Play Therapy for Dysregulated Clients ($135.00) 2-4-6-8 This is How We Regulate: Play Therapy for Dysregulated Clients Paired With Finding Meaning with Mandalas--2 days ($250.00) 6 Contact Hours In-Person (Elizabethtown, KY) * May 11, 2023 * 9:00 AM - 4:30 PM EST Tracy Turner Bumberry, LPC, RPT-S, CASFinding Meaning with Mandalas: Mandala Creation in Play Therapy Sessions with Tracy Turner-Bumberry Finding Meaning with Mandalas: Mandala Creation in Play Therapy Sessions ($135.00) Finding Meaning with Mandalas: Mandala Creation in Play Therapy Sessions Paired with 2-4-6-8 This is How We Regulate ($250.00) 6 Contact Hours In-Person (Elizabethtown, KY) * May 12, 2023 * 9:00 AM - 4:30 PM EST * Tracy Turner-Bumberry, LPC, RPT-S, CASContinuing Education needed (you may choose more than one): Play Therapy Counseling Marriage and Family Therapist Psychology Social Work EILA N/A - I'm a Student Other FRYSC If other, please list here* Any special accommodation?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. Name as it appears on the Credit Card* First Last Credit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.