Registration is limited to the first 16 registrants. Please provide a separate form for each registrant. Please go to the Online Registration form if you are paying by credit card.

If you are paying by check or money order, please print out this form, fill it out and send it with your payment to:

                                                                Bill Matulich Ph.D.

                                                                6333 Lake Kathleen Ave.

                                                                San Diego, CA  92119

NAME _______________________________________________________________

ADDRESS ____________________________________________________________

                    ____________________________________________________________

TELEPHONE _________________________________________________________

E-MAIL ______________________________________________________________

AGENCY _____________________________________________________________

_________ I have enclosed a check or money order for my registration.

_________ My agency will be sending a check/money order for my tuition.

Please note that your registration is complete when payment is received and cleared by the bank. If your payment will come from another name or agency, please specify:

________________________________________________________