Consult Group Registration Form Professional Consultation Request Please complete this form and submit with payment. Thank you. Name(Required) First Last Email(Required) Phone(Required)Is it okay to Text you?(Required) YES NO License Type(s)(Required)Where are you located?(Required)Please tell me a little about yourself, your experience with play therapy and/or sand therapy, and your goals/needs for consultation or the consultation group….(Required)One on One Professional Consultation (1 hour) 1 Hour by Zoom 1 Hour In-Person in Elizabethtown, KY Individual Time (For 1 Hour) to Discuss any Professional Needs/Concerns/Questions–from mental health/private practice business topics to clinical topics/case consultation. Sand Therapy Consultation Group (Available June 17, 2024-July 29, 2024) ST-I want to attend, but can’t commit to all 6 groups–I will come as I can ($80.00 deposit require–will cover 2 groups) ST-I would like to pre-pay for all 6 groups–you receive 1 group for free ($200.00) Total Credit Card(Required)