Course 2 Registration

REGISTRANT INFORMATION
First Name
 Last Name
 Street Address
City, State, Zip
 Email (required)
 Telephone
Employer
 		Occupation
Work Street Address
 		City, State, Zip
Work Phone
 		Fax Number
Website URL
 		Licenses and Degrees

Tell us about yourself. Please check all that apply.

Master Level Therapist

Dietitian

Doctorate Level Clinician

Physician

Psychiatrist

Graduate Student

Undergraduate Student

I work in the eating disorders treatment field but 
     am not a clinician

I treat eating disorders in an
     outpatient setting

I treat eating disorders in an inpatient setting 

Are you a member of iaedp™?

No  Yes

Do you treat eating disorders? 

No  Yes

Did you attend Symposium 2008?

No  Yes 

Have you ever attended an iaedp™ Symposium? (Check box)

I have never attended an iaedp™ Symposium

 

I have attended at least one iaedp™ Symposium

 

I have attended more than 2 iaedp™ Symposiums

 

I regularly attend iaedp™ Symposiums

 

Fees

 IAEDP Member, $100 

 IAEDP Non-Member, $125

 

 

Please contact iaedptm for assistance. 
**
providing education and certification
promoting effective treatment
iaedptm
The International Association of Eating Disorders Professionals Foundation 
serving the eating disorders professional community since 1985!
iaedptm is a non-profit 501c3 organization
PO Box 1295 * Pekin, IL 61555-1295
Voice: 800-800-8126 * Fax 800-800-8126 *


 

moncler down jacketsUGG ??? ??ugg cardy bootsmoncler saleair force onesChristian Louboutin Pumpsmoncler jackets womenuggs women classic tallugg classic tall boot chestnutugg australia classic tall boot