REGISTRATION:  
$20 NON-REFUNDABLE FEE THROUGH OCTOBER 13.  Limited scholarships available.  Check the scholarship box below.  
 
Name: ___________________________________ Age:  ______  Gender:  ______
 
Marital Status: __ single/never married; __ single/divorced __ married; __ divorced/remarried;
 
Address: _________________________ City: ________________  State:  ____  Zip:  ______
 
Phone Number: (      )  _____________Email:  ________________
 
Church/Address: ___________________________________________________

How did you hear about this conference?  ______________________________
 
Occupation (if student, are you undergraduate or graduate):  _____________
 
___ First time attending ___  Attended before, how many years? ____
 
To assist with accommodations, please list the number of the workshops you plan to attend.
I plan to attend the following AM Workshop:  ___  PM Workshop: ___
 
___ $20 for registrations postmarked by OCTOBER 13th
___ $30 for late registration after OCTOBER 13th or at the door
___ Additional $30 for Continuing Education Units.
___ $10 for students


___ TOTAL amount enclosed

Easy to Register:

1. On Line Registration with Credit Card:  This form is on line at wabashfriendscounseling.com.  Click on Day of Healing, registration.  There is no extra charge for this.
2. By Mail:  Make Checks payable to Wabash Friends Counseling Center, and send it to 3563 South State Road 13, Wabash, IN  46992
3. Phone with Credit Card:  Call 877.350.1658.