TraumaPlay 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 RegistrationStudentKAYPT Member4 or more people from my agencyHow are you registering today?*KYAPT Board MemberBrighter Futures Counseling EmployeeWon free registrationPaid by phone/check/PO (including lunch)Paid by phone/check/PO (NOT including lunch)Standard Registration* Price: $250.00 Agency Pricing* Price: $225.00 Cost for Students* Price: $200.00 Cost for KYAPT Board Members* Price: $0.00 Cost for KYAPT Members* Price: $225.00 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 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.