EMDR and Meditation - REGISTRATION FORM

 
Title of Workshop:____________________________________

Date and Location:____________________________________

             Name:____________________________________
	


 Degree/License #:____________________________________

                                  	

     Bus. Address:____________________________________

                  ____________________________________

             City:____________________________________

            State:______________________ Zip__________                   

       Bus. Phone:____________________________________

           e-mail:____________________________________


Please make check(s) payable and send to:
 
William M Zangwill, Ph.D.
124 W 93rd St. #9F
New York, NY 10025

For additional information, please contact me
at the address above, by e-mail or phone:

wzangwill@aol.com
(212) 663-2989.