REGISTRATION FORM

The Neuropsychology Center

2008 Small Group Advanced Seminars

Dallas, Texas

Indicate which sessions you wish to attend:

____ Forensic (July 7 – 9)
____ Comprehensive Clinical (August 27 – 29)

Your Name (as you want it to appear on CE certificate):

_______________________________________________________________________

Mailing Address: _________________________________________________________

______________________________________________________________________

____________________________________________________ Zip: _______________

Phone: ___________________ E-Mail: ________________________________________

Which Reitan Neuropsychology Labs workshop or The Neuropsychology Center seminar did you attend? Indicate dates, city, and topic for at least one workshop:

_____________________________________________________________________________

Registration fee:

Enclose a check to The Neuropsychology Center for the appropriate registration fee.

Early Registration fee - $400:

• Must be postmarked prior to June 21 for the Forensic session
• Must be postmarked prior to August 9 for the Comprehensive Clinical session

Late Registration: $450

Mail this form with payment to:

The Neuropsychology Center, P.C.
9400 N. Central Expressway, Suite 904
Dallas, TX 75231