Roland Williams, MA, NCACII, CADCII, ACRPS, SAP is Facilitating the

3 DAY CENAPS RELAPSE PREVENTION COUNSELING CERTIFICATION SCHOOL

FEBRUARY 29, MARCH 1 AND MARCH 2, 2008

Sacramento, CA.

 

REGISTRATION FORM

(PRINT THIS FORM)

 

Please complete this form for each applicant and mail with check or money order payable to:  

(I'm sorry that we are unable to process credit cards at this time)

Roland Williams, CEO

Free Life Recovery Center,

179 Lynch Creek Way, Petaluma, CA. 94954

                                    

Name:  _________________________________________________Phone #: _____________________________

Credentials:  __________________________________  Email Address: __________________________________

Your Organization: _______________________________________ Job Title: _____________________________

Your Mailing Address:__________________________________________________________________________

City: ________________________________________  State:  _______________  Zipcode: __________________

 

SPACE IS LIMITED YOU MUST PRE-REGISTER TO ATTEND !

Price $395. includes all training materials and continental breakfast.

 

Payment Options :           Circle One

                                         A:  $100 non-refundable deposit due with registration, balance of $295 due by

                                               February 15, 2008

                                         B:  $350 early registration discount price. Full amount must be paid in full prior                                                                 to December 31, 2007.

                                         C.  $325 per person with registrations of 10 or more. Registrations for all applicants                                                must be mailed together in the same envelope with payments.

PROGRAM INFORMATION PACKAGE WILL BE MAILED TO YOU UPON RECIEPT OF YOUR PAYMENT. INFO WILL INCLUDE DETAILS ABOUT THE TRAINING AND PREPARATION SUGGESTIONS, AS THIS IS AN INTENSIVE, EXPERIENTIAL TRAINING PROCESS.