INTERNATIONAL SUMMER INSTITUTE 2011

Hotel Las Palapas

Playa del Carmen, Mexico

June 19-24, 2011

REGISTRATION FORM

Name ____________________________________________________________________________________________

Address (street/city/state/country/code) _________________________________________________________________

Email __________________________________Phone ______________________ Fax ___________________________

Credit Card (MC/VISA/Discover) #________________________ Signature __________________ Exp. Date _________

Total amount to be charged _______________

Arrival Date ______________________________ Departure Date ____________________________________

Professional Affiliation ___ Psychologist ___ MFT ___ LPC ___ Physician ___ Attorney ___ OD Consultant ___ Other

Please check all boxes that apply.

* INTERNATIONAL SUMMER INSTITUTE

* Before May 15th 895 US$ (Includes daily breakfast buffet, beach buffet receptions, postmodern salon & study materials)

* After May 15th 995 US$
* Accompanying person: 50 US$ (add to registration fee-includes beach buffet receptions, and other social and cultural events)*

Total: __________________________

INTERNATIONAL SUMMER INSTITUTE 2011

SUPERVISION and TRAINING REFRESHER DAY

Hotel Las Palapas

Playa del Carmen, Mexico

June 19, 2011

REGISTRATION FORM

Please check all boxes that apply.

* INTERNATIONAL SUMMER INSTITUTE SUPERVISION REFRESHER DAY
* Before May 15th 95 US$ (Includes daily breakfast buffet, beach buffet receptions, postmodern salon & study materials)

* After May 15th 125 US$
* SUPERVISION REFRESHER DAY is complimntary for those attending the ISI. Check here to register: You must register. Thank you!

Total: __________________________

Please check all boxes that apply.

* INTERNATIONAL SUMMER INSTITUTE CONSULTATION DAY
* Before May 15th 95 US$ (Includes daily breakfast buffet, beach buffet receptions, postmodern salon & study materials)

* After May 15th 125 US$
* CONSULTATION DAY is complimntary for those attending the ISI. Check here to register: You must register. Thank you!

Total: __________________________

Cancellations: Fee is non-refundable unless a program is filled, cancelled or the refund is requested prior to June 1, 2011). Cancellation fee: $75.

Receipts: Canceled checks and credit card statements will serve as receipts. No additional receipts will be provided, unless requested.

Hotel Registration: Participants are responsible for making their hotel reservations and paying the hotel directly. Please contact Maripaz Bojorges at the Las Palapas Hotel and tell her that you are with the International Summer Institute (ISI). If you plan to arrive early or stay a few days after the ISI, you will receive the same ISI discounted daily hotel room rate. No charge for children 6 years old and younger.

*Room prices are based on double occupany and include taxes.

Hotel Las Palapas

Playa del Carmen, Mexico

Tel 52-984-8734260

Fax 52-984-8730458

info@laspalapas.com

http://www.laspalapas.com/

* Family members and friends who accompany participants to Playa are invited to the receptions and cultural events. Fee is 50 US$ per person

**Room mates: If you need help with a room mate, please contact HGI for possibilities.

To register and for questions:

Phone 1-713-526-8390; Fax 1-713-528-2618; Email admin@talkhgi.com

Spanish speaking participants please contact: sylvialondon@yahoo.com