Intensive Four-Day Workshop
Intensive Four-Day Workshop in Exposure and Response Prevention (ERP) forObsessive-Compulsive Disorder (OCD)March 9-12, 2020Registration FormLast Name: First Name:Work Agency: Profession:Work Address: City:State:Zip:Work Phone: Ext: Home Address:City:State:Zip: Email Address: Briefly describe prior treatment experience: Fee: - $1,600Form of Payment FORMCHECKBOX Check Please make check or money order payable to “CPUP” and mail to: Center for Treatment & Study of Anxiety, ATTN.: Ellen Kubis, 3535 Market Street, 6th Floor, Philadelphia, PA 19104 FORMCHECKBOX Credit Card (VISA, MC, Discover) – no AMEX is accepted Name as it appears on card: Card #: Expiration Date: Sec. #: ................
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