Registration Form

Motivational Interviewing Workshops


 
 
 



Registration is limited to the first 20 registrants in each workshop (10 in the advanced workshop). Please provide a separate form for each registrant. Please go to the Online Registration form if you are paying by credit card or PayPal.

  

    
       Feb. 10 & 11, 2018: INTRO
    
       April 28 & 29, 2018: INTRO



If you are paying by check or money order, please print out this form, fill it out and send it with your payment to:

                                                                William J. Matulich Ph.D.

                                                                6333 Lake Kathleen Ave.

                                                                San Diego, CA  92119


NAME _______________________________________________________________


ADDRESS ____________________________________________________________


                    ____________________________________________________________


TELEPHONE _________________________________________________________


E-MAIL ______________________________________________________________


AGENCY _____________________________________________________________


_________ I have enclosed a check or money order for my registration.


_________ My agency will be sending a check/money order for my tuition.


Please note that your registration is complete when payment is received and cleared by the bank. If your payment will come from another name or agency, please specify:


________________________________________________________