Eliana Gil–Using Play in Family Therapy Registration Full Name of Person attending the training:* First Last Name as you would like it appear on nametag:* Do you have a promo code? How are you registering today?* Standard Registration Student 4 or more people from my agency How are you registering today?* Brighter Futures Counseling Employee Won free registration Paid by phone/check/PO (including lunch) Paid by phone/check/PO (NOT including lunch) Standard Registration* Price: Agency Pricing* Price: Cost for Students* Price: Cost for BFC* Price: Free Registration* Price: Alternate Payment (check/phone/PO)* Price: License/Credentials* Occupation* Agency or School* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Continuing 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* Lunch OptionsA buffet style lunch will be offered daily. Please select from options below. We will try to accommodate special dietary needs. Which days would you like lunch?* Day One Day Two Both Days No Thanks! Which days would you like lunch?* Day One Day Two Both Days No Thanks! Any special accommodation requests including dietary needs?Total Cost of Registration and Meals (Breakfast & Snacks Included): $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 Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.