MPC Registration Form: 2001-2002

Print out the form, shown below, and return it with a
$25 non-refundable registration fee for each course to:

  Ruth Rosenthal, Ph.D.
4572 South Hagadorn Road, Suite 2E
East Lansing, Michigan 48823
(517) 333-4455
e-mail: 

Please send one form for each course.

There is an aditional $25 late registration fee after August 1, 2001
for each Fall course, and December 1, 2001 for each Winter course.

Course                                                                                                                                       

Semester:   [ ] Fall     [ ] Winter        Site:                                                                                

Name                                                                                                                                         

Address                                                                                                                                     

Occupation                                                                                                                                

Phone (Day)                                                                (Evening)                                             

E-mail                                                                 

Membership Status in MPC   [ ] Member     [ ] Request for Membership

Training Program Status in MPC     [ ] Candidate

Submit forms by August 1, 2001.

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