MPC Registration Form
Print out the form, shown below, and return it with a $25 non-refundable registration fee for each course to:
Diane Burgermeister, Ph.D
31487 Northwestern Hwy., Ste A
Farmington Hills, Michigan 48334
Please send one form for each course.
There is an additional $25 late registration fee after August 1, 2008
for each Fall course, December 1, 2008 for each Winter course, and Janaury 30, 2009
for each Spring course.
Semester: [ ] Fall [ ] Winter [ ] Spring Site:
Phone (Day) (Evening)
Membership Status in MPC [ ] Member [ ] Request for Membership
Training Program Status in MPC [ ] Candidate