Expressive Art Therapy Summer Institute - Prescott College
Expressive Art Therapy Summer Institute - Prescott College
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!