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Expressive Art Therapy Summer Institute - Prescott College

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<strong>Expressive</strong> <strong>Art</strong> <strong>Therapy</strong> <strong>Summer</strong> <strong>Institute</strong><br />

Registration Form<br />

Name<br />

Address<br />

City/State/Zip<br />

Phone<br />

Email<br />

Birth Date<br />

Emergency Contact Name/ Phone<br />

I would like to volunteer to share a gift of Morning Wellness<br />

I am a beginning MAP CP/EAT student<br />

I am a continuing MAP CP/EAT student<br />

I am enrolling in a <strong>Summer</strong> Semester 2012 M.A. EAT course<br />

How did you hear about the <strong>Institute</strong>?<br />

Full <strong>Institute</strong> $ 2000<br />

Individual Classes:<br />

Intentions and Aspirations – Camille Smith/Pat B. Allen (July 22) $90<br />

The Power of Tribe – Pat B. Allen (July 23-24) – $330<br />

Courage, Compassion, Connection, and Creativity – Camille Smith (July 25-27) $500<br />

Movement Matters – Debra McCall (July 28-30) $500<br />

Spirit Wands – Kat Kirby (July 31) $90<br />

Integrating the Power of Music and Sound – Anne Parker (August 1-2) $330<br />

The <strong>Art</strong> of Happiness – Cathy Malchiodi (August 3-4) $330<br />

The Creative Bridge – Camille Smith (August 5) $165<br />

Total Enclosed $<br />

VISA Mastercard AMEX Discover<br />

Account Number<br />

Expiration Date<br />

Billing address<br />

3 or 4 Digit Verification Code<br />

Name as it appears on card<br />

Signature<br />

Refunds:<br />

Cancellation by June 22, 2012 – all but $200 / Cancellation after June 23, 2012 – no refund<br />

Make checks payable to <strong>Prescott</strong> <strong>College</strong> and Mail to:<br />

Cheryl Schwartz<br />

Lifelong Learning Center at <strong>Prescott</strong> <strong>College</strong><br />

220 Grove Ave., <strong>Prescott</strong>, AZ 86301<br />

• A participant agreement is required for registration- found at<br />

www.prescott.edu/lifelong-learning<br />

• Scholarships are available for continuing students enrolled in the <strong>Prescott</strong> <strong>College</strong> Master<br />

of <strong>Art</strong>s Program EAT concentration. The deadline to apply is May 11, 2012.<br />

• The Scholarship application is available from the EATSI website link:<br />

http://www.prescott.edu/lifelong-learning<br />

• Should a presenter need to cancel, a qualified presenter will teach.<br />

CLASS SIZE IS LIMITED, SO REGISTER TODAY!

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