C. G. Jung Institute of Los Angeles - Public Programs Registration Form

Please Print The Order Form Below and Fax or Mail
Close this Window to Return to Public Programs

Sandplay Registration Form
C. G. Jung Institute
10349 West Pico Boulevard, Los Angeles, CA 90064
Tel: (310)556-1193 Fax: (310)556-2290

Name

Address

City___________________ State______ Zip_______

Home Phone_____________________________

Office Phone_____________________________

Email ___________________________________

License number_________________________

Applicants must be licensed professionals.

Please enroll me in:

Jungian Psychology & Sandplay ($505.00)

(8-Month Course)

Jungian Psychology & Sandplay tuition is $480.00 plus $25 materials fee.
Enrollment is limited.
The class is for licensed practitioners, registered interns and social work associates. In addition to CE, CME and MCEP accreditation, credit is available for ISST (International Society of Sandplay Therapy) and STA (Sandplay Therapists of America).
Partial scholarship also available.

*There is an additional $10 processing fee (per certificate) for each continuing education course taken for credit.
Make check made payable to: C. G. Jung Institute.
or Visa or Mastercard

Credit Card Number

Expiration Date

Name on Card

Name

Address

Daytime Phone

If you are a licensed professional, please check the type of license you hold:

MFT/MFCC_____

LCSW_____

Psych_____

Other_____

REGISTRATION INFORMATION

Event Location (unless otherwise noted)
C. G. Jung Institute of Los Angeles
10349 W. Pico Blvd (one block east of Beverly Glen)
Los Angeles, CA 90064

Tuition/Reservations
To register using a credit card, please call (310) 556-1193, Monday-Friday, 9am-5pm.
Please note any special disability needs at the time of registration.

Student/Senior Discount
Full-time students (send a copy of I.D.) and seniors (60 or over) are eligible for the reduced tuition. Discounts for students and seniors will be $5 less than listed prices.

Refunds
One half of your registration fee is refundable if your cancellation is received two weeks prior to the event.

Close this Window to Return to Public Programs