| RESTORATIVE RETELLING: THE CREATIVE MASTERY OF TRAUMATIC GRIEF September 12 and 13, 2008 |
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| Registration Form | Please fill in all fields. If a field does not apply, please enter "NA" |
| Name and Credentials: | |
| Address: | |
| City, State and Zipcode: | |
| Phone Number: | |
| Alternate Phone Number: | |
| Email Address: | |
| Organization: | |
| Discipline: | |
| Social Worker License Number: | |
| Marriage and Family Therapist License Number: | |
| Mental Health Therapist License Number: | |
| Student: School and Program: |
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| Registration is limited to 150 participants. If you have questions, you may email Laura Jeffs at laura@vdbs.org or call (206) 223-6398. | |
| Please send registration payment of $50 (checks only) made out to Separation and Loss Services to: | |
| Separation and Loss Services Virginia Mason Medical Center PO Box 1930, D1-SPL Seattle, WA 98111 |
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| Training Location: | |
| Virginia Mason Medical Center Lindeman Pavilion, First Floor (Go downstairs from the main lobby on the second floor) Volney Richmond Auditorium 1201 Terry Avenue Seattle, WA 98111 |
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