How to Register

To register online, please fill out the form below and fax to 617-232-1280 or mail to: Shannon Smith, The Trauma Center at JRI, 1269 Beacon Street, Brookline, MA 02446. We will hold a space for three (3) business days, pending receipt of your payment.

Register by Mail

To register by mail, please print out the form below and send it with a check payable to “The Trauma Center at JRI” at 1269 Beacon Street, Brookline, MA 02446. Registration will be confirmed when payment is received. Space is limited, and registration will be on a first come, first served basis.

Registration Form

Personal Information:

Name:
Degree/Licensure:
Email Address:
Work Phone:
Home/Other Phone:
Street Address:

Standard Tuition Rate: $695:

Early Bird Rate: valid until 6/11/13: $595:

Student Rate: valid ONLY through 5/28/13: $505:

Group/Agency Rate: Register 5 people and get 6th person FREE: $2975:

Special Repeat Participant Discount: Registered 2012 TC Summer Institute Attendees receive 15% off early bird rate: valid ONLY through 5/28/13: $505:

Optional: Case Consultation with Dr. Fran Grossman: Additional Fee: $100 (limited to 3 participants on a first-come registration basis):

Optional: Become a Friend of the Trauma Center by supporting the 30th Anniversary Fund Drive Challenge Match to Establish the Endowed van der Kolk Research Directorship: $30: