REGISTRATION FORM
Halstead-Reitan
Neuropsychological Test
Administration and
Interpretation
TBA
Your Name (as you want it to appear on your CE certificate):
______________________________________________________________________
Mailing Address: ________________________________________________________
_____________________________________________________________________
_________________________________________________ Zip: _________________
Phone: _________________ E-Mail: _________________________________________
Occupation:
_____________________________________________________________
Enclose a check to The Neuropsychology Center for the appropriate registration fee
and costs.
Registration fee:
Early Registration fee (postmarked prior to TBA): $400
Late Registration fee (postmarked after TBA): $450
Amount enclosed: ______________
Mail this
form with payment to:
The
9400 N.
Central Expressway,