<p>OXFORD SYMPOSIUM IN SCHOOL-BASED FAMILY COUNSELING Registration Form</p><p>I wish to attend the Oxford Symposium in School-Based Family Counseling, August 9 - 14, 2015</p><p>Title: Dr. ___ Mrs.___ Ms.___ Mr.___ Professor___</p><p>Name: ______</p><p>Position: ______</p><p>Institution: ______</p><p>Address: ______</p><p>______</p><p>______</p><p>Telephone: ______</p><p>Fax: ______email: ______</p><p>I will be bringing a guest____ Name of Guest:______</p><p>Please enclose a check (or provide credit card information below) for your payment. Checks may be made out to: Institute for School-Based Family Counseling.</p><p>I authorize the Institute for School-Based Family Counseling to charge the credit card below for the amount of $______.00</p><p>Mastercard____ Visa_____</p><p>Card Number______</p><p>Expiration date: Month______Year______</p><p>Name as Printed on card:______</p><p>Signature:______Date:______</p><p>Send this form to Sheena Sattarpour, M.A.,MFTi, Coordinator: Oxford Symposium in SBFC as pdf to: [email protected] or by mail to: Sheena Sattarpour, M.A., MFTi, USF Center for Child & Family Development, 3250 19th Avenue, 4th Floor, San Francisco, CA 94131, USA OXFORD SYMPOSIUM IN SCHOOL-BASED FAMILY COUNSELING</p><p>2015 Oxford Symposium Registration Information</p><p>Symposium members make an initial registration deposit of $495 a second payment of $850 by April 15, 2015 and a final payment $850 by May 15, 2015</p><p>Registration payments for guests of Symposium members are due in full by May 15 ………………………………………………………………………………………………………………………………..</p><p>REGISTRATION RATES AND DISCOUNTS</p><p> Symposium member USD $2,195. Symposium members attend the morning formal conference sessions and usually (but not in every case) deliver a presentation (individual or co-presentation)</p><p> Symposium guest USD $1,595. Symposium guests do not attend the morning formal conference sessions</p><p> Group discount Symposium members (group of 2 or more, individual rooms) $2,195 less $400 discount for second and each subsequent member</p><p> Shared Room Discount $100 discount per shared room</p><p>………………………………………………………………………………………………………………………………….</p><p>CANCELLATION AND REFUNDS</p><p>Registrations paid are refundable in full up until May 25, 2015 Registrations paid are non-refundable after August 3, 2015 Registrations canceled between May 25 and August 3, 2015 will be subject to a refund declining by 10% each week ie. 90% is refundable if canceled by June 2; 80% if canceled by June 9 and so on ______email registration: [email protected] Sheena Sattarpour, M.A., MFTi email Symposium Director: [email protected] Dr. Brian Gerrard web: http://web.usfca.edu/soe/ctrs_institutes/ccfd/oxford_symposium</p>