|
Please return this form with the appropriate fee. You will
be sent a brief, multiple-choice exam to complete after viewing the tapes.
Return your completed questionnaire to the address listed below and a CEU
certificate will be issued for the total number of credits obtained. Cost =
$10.00 per CEU
Name __________________________________ Degree_______
Address____________________________________________________
Phone _____________________ State License#______________
Email ________________________________________________
Total enclosed for ____ tape(s) for which I seek CEUs
= $______ DVDs /Videos (check all that apply)
|
□ Fanita English
“Permissions” |
□ Claude Steiner
“Strokes” |
□ Mary Goulding
“Redecisions” |
□ TA 101
Spanish/English |
□ Gloria Noriega
“Codependency…” |
□ Robert & Mary Goulding
“Redecision
Therapy” |
| □Ellyn Bader & Peter Pearson “Couples
Therapy…” |
□ George Kohlreiser “Conflict
Management…” |
□ Abe Wagner ”Breaking the Communication
Barrier” |
| □ Robert Goulding “Scripts” |
□ Vann Joines “…Treatment
Planning…” |
□ Muriel James ”Ego States…”
& ”Self Reparenting…” |
| □ Fanita English “Forces…”
|
□ Claude Steiner “Emotional Literacy
….” |
□ Jack Dusay “TA Evolution” |
| |
□ Stephen Karpman “Game Free …”
|
|
Payment Options (Payment must be in US funds drawn
on a US bank)
□ Check □ Visa □ MasterCard □
American Express
___________________________________________ Exp.
Date:___________
Signature:___________________________________________________
ITAA, 2186 Rheem Drive #B-1, Pleasanton, CA 94588-2775, USA; or fax to: +1 925 600 8112 |
