Registration Form


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Next, fill out the printed form and then:

Fax to 916-939-7723

or

Mail to:

Scott Brandt Seminars
2600 E. Bidwell, Suite 220
Folsom, CA 95630

Payment Must Accompany Registration

Registrants must be in attendance for the entire course time to receive credit.
Late arrivals and early departures will not receive credit for the course.

Name:________________________________________________________

Address: _____________________________________________________

City: ___________________________ State: ______ ZIP: ______________

Phone: (_____) _________________________

 

Status: Licensee, License #: _______________
  Student
  Intern

 

Seminars
1. Effective Treatment of Borderline & Narcissistic Personality Disorders
Date: TBD  
  Location:
TBD
 
Date: TBD  
  Location:
TBD
 
Date: TBD  
  Location:
TBD
 
  BBS Provider #PCE 328
7 CEUs
   
2.
Treatment of the Personality Disordered Couple
Date: TBD  
  Location:
TBD
 
Date: TBD  
  Location:
TBD
 
Date: TBD  
  Location:
TBD
 
  BBS Provider #PCE 328
7 CEUs
   
3.
Narcissistic Personality Disorder Technique of Intervention
  Date: TBD  
  Location:
TBD
 
  BBS Provider #PCE 328
7 CEUs
   
4.
Evaluation and Treatment of the Personality Disordered Adolescent
Date: TBD  
  Location:
TBD
 
Date: TBD  
  Location:
TBD
 
  BBS Provider #PCE 328
7 CEUs
   
5.
Case Consultation Seminar: Diagnosis and Treatment of Personality Disorders
  First Monthly Meeting: March 9, 2013
Last Monthly Meeting: August 10, 2013
Time: 9:00 a.m. to 12:00 p.m.
 
  Location:
Chico, CA
 
  BBS Provider #PCE 328
18 CEUs
     
6.
Case Consultation Seminar: Diagnosis and Treatment of Personality Disorders
  First Monthly Meeting: February 2, 2013
Last Monthly Meeting:August 3, 2013
Time: 9:00 a.m. to 11:00 a.m.
 
  Location:
Folsom, CA -- 2600 E. Bidwell St., Suite 220, Folsom CA 95630
 
  BBS Provider #PCE 328
12 CEUs

 

Register Early to Save
  Postmarked or dated up to 3 weeks before each seminar:  
  Licensed Professionals
$130 Per Course
 
  Student/Intern
$100 Per Course
 
       
  Postmarked within 3 weeks before each seminar:  
  Licensed Professionals
$150 Per Course
 
  Student/Intern
$110 Per Course
 
       
Course 5
    $150 per weekly meeting  
    $150 Registration
for 1st month's meeting
 
       
Course 6
    $60 per session  
    $60 Registration
for 1st month's meeting
 
       
Refund Policy
  No refund made within 7 days prior to each seminar. Refunds are made less a $25 processing fee.  

 

Payment Method
Method:

VISA

  MasterCard
 

Check
Make checks payable to Scott D. Brandt, Ph.D.

Card #: ______________________________________
Expiration Date: _______________________
Signature: ____________________________________
CVC Code (3-digit code on back of card): _______________