REGISTRATION:
Checks Accepted at Event or Pre-register using the form below.
For Continuing Education Credit, please bring License Number*

Michael Conforti, Ph.D.

Hidden Presences
Friday, January 15, 2010    7:00 - 9:00 p.m. Lecture

Dreams: Expressions of Eternal Wisdom
Saturday, January 16, 2010  10:00 a.m. to 4:00 p.m  Workshop
Lunch not provided. Cafeteria services available at Sarasota Memorial Hospital, or bring bag lunch.

Sarasota Memorial Hospital
Waldemere Auditorium
1700 S. Tamiami Trail, Sarasota

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DATE:   ____________
NAME:  ____________________________________________________   TEL:  ________________
E-MAIL:  _____________________________________
ADDRESS:  _________________________________________________________________
CITY:  __________________________    STATE:  ______________________    ZIP:  ________________

COST:
Early Registration Discount for Jung Society Members/SMHC Staff & Employees Only
Register with Payment Before January 9, 2010
Lecture plus Workshop
______$55 members C.G. Jung Society of Sarasota/SMHC Staff & Employees

Pay at Event:
Lecture
______$15 members C.G. Jung Society of Sarasota/SMHC Staff & Employees
______$20 non-members
______$10 students
Workshop
______$50 members C.G. Jung Society of Sarasota/SMHC Staff & Employees
______$60 non-members
______$25 students
CEUs provided by Sarasota Memorial Health Care System*: 
______$10  2 Hrs Friday Lecture
______$25  5 Hrs Saturday Workshop

Amount enclosed:
$_____________ (Make check payable to C.G. Jung Society of Sarasota)

Mail registration form and checks to:

The C.G. Jung Society of Sarasota
P. O. Box 50611
Sarasota, FL 34232

* Sarasota Memorial Health Care System is accredited as a provider of continuing education in nursing by the Florida Board of Nursing, #FBN 2120.
Two hours of continuing education credits will be awarded for the lecture, and five hours of continuing education credits for the workshop.

Through Sarasota Memorial Health Care System this program meets the criteria for continuing education from the Board of Clinical Social Workers, Marriage and Family Therapy, and Mental Health Counseling, #BAP-377.  Two hours of continuing education credits will be awarded for the lecture, and five hours of continuing education credits for the workshop.