TraumaPlay Registration Name* First Last Name as you would like it appear on nametag:*Are you a student or KAPT Board Member?*I am a studentI am a KAPT Board MemberNoDo you have a promo code?Standard Registration* Price: $250.00 Cost for Student and KAPT Board Members* Price: $200.00 Cost for BFC* 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 Other N/A - I'm a Student GILA 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!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. Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.