The Children’s Treehouse Foundation Psychosocial Intervention

Training Workshop, Sept. 18-20, 2008, Courtyard Marriott Denver

(Please complete one reservation form for each person attending. Summarize the payment on just one form, if more than one person is attending.)

Attendee(s) Name: (Please print) ___________________________________________

Home address: ____________________________________________

City, State, Zip: ____________________________________________

Employer: _______________________________________________________________

Work address: ____________________________________________________________

City, State. Zip: ___________________________________________________________

Preference (check one): home address ________ work address _______________

Home phone: _____________________ Best time to call ____________________

Work phone: _____________________ Best time to call ____________________

Fax: ____________________________

Preference (check one) home phone____ Work phone ______

Email: _________________________________________________

Position title: ____________________________________________

Please indicate your area of expertise (LCSW, RN, OTR, Nurse Practitioner, Clergy, art therapist, dance therapist, other)

Day arriving: _____________________ Day departing: ___________________

__________________________________________________________________

Payment summary:

Number of individuals:_________ One ——— @$500.00: ________

Others: _____ @$350.00: ________

NASW Certificates ordered @ $12.00: ________

ONS Certificates ordered NC ________

Total remitted: __________________

Please make a copy of this form, complete it, and return it with your remittance.

Please submit a check payable to The Children’s Treehouse Foundation, 50 South Steele St., Suite 430, Denver, Colorado 80209. Upon receipt, we will then confirm your reservation.

Hotel Reservation: A special workshop rate of $129. 00 has been obtained at the Courtyard Marriott Denver, Downtown, for reservations made prior to Sept 3. Please make your reservation directly by clicking on either of the two links below or the one on the first page. You will go directly to the property’s home page with our code already entered. All you need to do to start the process is to enter your arrival date.

Courtyard Denver Downtown
The workshop is supported by an unrestricted grant from the Avon Foundation.