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 RegistrationStudent4 or more people from my agencyHow are you registering today?*Brighter Futures Counseling EmployeeWon free registrationPaid by phone/check/PO (including lunch)Paid by phone/check/PO (NOT including lunch)Standard Registration* Price: $150.00 Agency Pricing* Price: $125.00 Cost for Students* Price: $125.00 Cost for BFC* Price: $0.00 Free Registration* Price: $0.00 Alternate Payment (check/phone/PO)* Price: $0.00 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 OneDay TwoBoth DaysNo Thanks!Which days would you like lunch?*Day OneDay TwoBoth DaysNo 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 ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.