Registration Form
HBLU: Healing Trauma & Installing Boundaries

Schedule:
Friday, May 2nd 9:00 am-6:00 pm
Saturday, May 3rd 8:30 am – 5:00 pm
Friday, May 9th 9:00 am – 6:00 pm
Saturday, May 10th 8:30 am – 5:00 pm

Course Location:
Pepperdine University
18111 Von Karman Avenue, 2nd Floor
Irvine, CA 92612

Course Investment:
___$720 early registration by April 11th
___$630 per person for groups of 2 or more
___$810 regular registration
___$360 for graduate student or intern**
___$315 repeating class

More Information: www.hblu.org

Mail Registration:
Amy St. Hilaire, MFT
the Center: Therapies for Mind~Body~Spirit, LLC
23121 Verdugo Drive, #200
Laguna Hills, CA 92653

Phone Registration: 949.916.1100
Fax Registration: 949.716.7608
Email Registration: amysthilaire@get-centered.com

Name____________________________________
Address__________________________________
______________________Zip________________
Phone________________Email_______________
Profession_____________License #____________

Payment Method
___Check payable to “the Center: TFMBS”
___Visa ___MasterCard Card#____________________________________
Exp. Date_______ 3 digit security code________

Signature_________________________________

Cancellations received up to one week before the training are refundable less a $50 administrative fee.

** Graduate Students/Interns: please submit proof of full-time student status or a letter from your current supervisor with his/her degree and license information along with your registration form