Conference Registration Form

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Reynold Watts
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1 Friday, October 30, 2015 On-line registration is available on our website at: or you may send this registration form with your check or your credit card information or your purchase order payment to: Molloy College, Division of Continuing Education, PO Box 5002., Rockville Centre, NY You may also phone in your registration by calling or fax in your registration by calling with your Visa or MasterCard information or purchase order information. A confirmation, with directions to the campus, will be sent upon receipt of your registration. Participants are also asked to pre-register for the concurrent session topics that they would like to attend since seating will be limited in most of the sessions. Periods/Dates Fee Early, until September 30 $40 Regular, October 1-23 $50 Late, October 24-29: $60 October 30: $70 Molloy Students, Faculty and Staff (provide copy of student ID, must register by September 30 No charge Non-Molloy Students (provide copy of student ID, must register by September 30): $15 Molloy Alumni 10% discount The Rebecca Center for Music Therapy at Molloy College Presents: International Perspectives on Improvisational Music Therapy and ASD: NON-PROFIT ORGANIZATION U.S. POSTAGE PAID MOLLOY COLLEGE Conference Form Clinical Practice and Research Name Organization Home Address City State Zip Home Phone Cell Phone Payment Method q Enclosed is my check or money order made payable to Molloy College q Enclosed is a purchase order q Please charge the Conference fee to my credit card: q Visa q MC # Division of Continuing Education and Professional Development 1000 Hempstead Avenue, PO Box 5002 Rockville Centre, NY Work Phone A One-Day Conference for Music Therapists and Other Health Care Professionals such as: Psychologists, Teachers, Occupational Therapists, Physical Therapists, Speech and Language Pathologists, Counselors, Creative Arts Therapists Friday, October 30, 2015; 8:30 a.m.-5:00 p.m. Madison Theatre, Public Square, Rockville Centre Campus Exp. Date V Code (3 digit code on back of card) Name on the card Signature Music Therapy Conference Brochure 2015.indd 1 9/1/2015 1:32:50 PM

2 and Continental fast (fast Provided by : 1 (Session descriptions and speaker bios can be the three Early, until September 30: $40 Regular, October 1-23: $50 Late, October 24-29: $60

3 and Continental fast (fast Provided by : 1 (Session descriptions and speaker bios can be the three Early, until September 30: $40 Regular, October 1-23: $50 Late, October 24-29: $60

4 and Continental fast (fast Provided by : 1 (Session descriptions and speaker bios can be the three Early, until September 30: $40 Regular, October 1-23: $50 Late, October 24-29: $60

5 Friday, October 30, 2015 On-line registration is available on our website at: or you may send this registration form with your check or your credit card information or your purchase order payment to: Molloy College, Division of Continuing Education, PO Box 5002., Rockville Centre, NY You may also phone in your registration by calling or fax in your registration by calling with your Visa or MasterCard information or purchase order information. A confirmation, with directions to the campus, will be sent upon receipt of your registration. Participants are also asked to pre-register for the concurrent session topics that they would like to attend since seating will be limited in most of the sessions. Periods/Dates Fee Early, until September 30 $40 Regular, October 1-23 $50 Late, October 24-29: $60 October 30: $70 Molloy Students, Faculty and Staff (provide copy of student ID, must register by September 30 No charge Non-Molloy Students (provide copy of student ID, must register by September 30): $15 Molloy Alumni 10% discount The Rebecca Center for Music Therapy at Molloy College Presents: International Perspectives on Improvisational Music Therapy and ASD: NON-PROFIT ORGANIZATION U.S. POSTAGE PAID MOLLOY COLLEGE Conference Form Clinical Practice and Research Name Organization Home Address City State Zip Home Phone Cell Phone Payment Method q Enclosed is my check or money order made payable to Molloy College q Enclosed is a purchase order q Please charge the Conference fee to my credit card: q Visa q MC # Division of Continuing Education and Professional Development 1000 Hempstead Avenue, PO Box 5002 Rockville Centre, NY Work Phone A One-Day Conference for Music Therapists and Other Health Care Professionals such as: Psychologists, Teachers, Occupational Therapists, Physical Therapists, Speech and Language Pathologists, Counselors, Creative Arts Therapists Friday, October 30, 2015; 8:30 a.m.-5:00 p.m. Madison Theatre, Public Square, Rockville Centre Campus Exp. Date V Code (3 digit code on back of card) Name on the card Signature Music Therapy Conference Brochure 2015.indd 1 9/1/2015 1:32:50 PM

Developmental Interventions

Friday, May 1, 2015 Developmental Interventions for Autism: NON-PROFIT ORGANIZATION U.S. POSTAGE PAID MOLLOY COLLEGE Conference Registration Form On-line registration is available on our website at: www.molloy.edu/ce/musictherapy