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, 2006
for each Fall course, and December 1, 2006 for each Winter course.
Semester: [ ] Fall [ ] Winter Site:
Phone (Day) (Evening)
Membership Status in MPC [ ] Member [ ] Request for Membership
Training Program Status in MPC [ ] Candidate