Children’s Group Therapy Association
P.O. Box 521
Watertown, MA 02472
www.cgta.net

CONFERENCE COMMITTEE
Sandy Houde, LICSW, Co-Chair
Pam O'Callaghan, M.Ed., Co-Chair

Regina Cancelliere Casey, LICSW
Karen Caprenter, APRN, SNPJD
Jim Caron, Ed.D., CGP
Hyaeeun Sophia Chun, MSW
Sandy Houde, LICSW, CGP- Conference Assistants
Heather McKeone, MSW
Pam O’Callaghan, M.Ed., NCC- CEU coordinator
Amy Porreca, MSW - Registration Coordinator
Adele Pressman, MD
Jennie Shaw, LICSW


THE CHILDREN’S GROUP THERAPY ASSOCIATION

CGTA was established by a group of professionals actively involved in the field of children’s group therapy. The association functions as a support system for group therapists, and as an advocate for quality group services for children, adolescents and parents. CGTA is committed to providing training opportunities, and expanding resources and networking in the field. Membership in CGTA is open to all professionals invested in child and adolescent group therapy.

2009 - CGTA FALL CONFERENCE REGISTRATION FORM

PLEASE REGISTER EARLY
Mail in registration must be postmarked by September 28th

To print this page: Press "Print Screen" or Go to "File", select "Print".
Duplicate as needed. Registration must be postmarked by September 28th.

Name: _________________________________ License/Degree:____________
Profession: ________________________________________________________
Address: ____________________________________E-mail:________________
City:________________________________________State:_______Zip:_______
Home Phone: ( )____________________Work Phone: ( ) _______________
Work Place: _______________________________________________________

How did you hear about the CGTA Conference? ___________________________


Early registration postmarked by 9/14/09 (includes luncheon and cost of CEUs)
$ 95.00 Non member
 ___________
$ 75.00 CGTA Member
 ___________
$ 55.00 Student/Unemployed Professionals
 ___________
   
Pre-registration postmarked by 9/28/09 (includes luncheon and cost of CEUs)
$ 105.00 Non member
 ___________
$ 85.00 CGTA Member
 ___________
$ 65.00 Student/Unemployed Professionals
 ___________
   
10% Discount for groups of 5 or more registering together (sent in together)  

Membership:
__ I am joining CGTA with this application (pay member rate for Conference)
__ $50.00 Full __ $30.00 Student __ $90.00 Institutional
New Membership:
 ___________
Renewing membership:
 ___________

Total - Payable to "CGTA": $

Cancellation Policy: Refund requests must be made in writing and postmarked by September 21, 2009 and are subject to a $25.00 administrative fee. No registration refunds after September 21st.

Detach and Mail to:

    CGTA Conference
    c/o Pam O'Callighan
    14 Knight Rd.
    Framingham, MA 01701

For more information call:

    Pam O’Callaghan
    617-796-0150
    or visit our website www.cgta.net

Confirmations will not be sent