CAEOP REGISTRATION FORM
Your registration fee will include the cost of Dr. Gross’ book that will be sent to you, or emailed if you choose the electronic version, after you register. Please indicate on the registration form which version you prefer; or, if you pay with a credit card, by the PurplePass weblink on the form.

THERE ARE TWO STEPS: 1) COMPLETE THIS ONLINE FORM. 2) COMPLETE PAYMENT(PurplePass or a check)


CONFERENCE REGISTRATION FEES: $75 Early Bird with advanced registration prior to December 2, or $85 if registering between December 2nd and December 11, 2020. (Walk-ins are also welcome).
 Ideally, we prefer if you register HERE, online at: https://forms.gle/pNSrJMxryPkHUWFs5
If you must use snail mail, please send  a check payable to CAEOP to:  Chrystie Cruz, CAEOP Treasurer, 126 Park Avenue, Wahlstrom Library, Room 519,  Bridgeport, CT  06604,   after you have completed this form.                          

TO PAY WITH A CREDIT CARD, please go to: www.purplepass.com/traumaStrategies
QUESTIONS?? Contact David Johnston at: educationrwe2@gmail.com, or via phone at: 203.640.6201.
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Email *
First Name
Last Name Name
Title/Responsibility
Affiliation
Telephone(indicate if cell)
Email
Amount Enclosed
Indicate team member(s) attending with you
I prefer this edition of the book:
Number of copies if this registration covers multiple registrants:
Number of registrants:
Method for payment *
If you have requested a hard copy of the book, which address would you like it sent to? (if you have requested an electronic copy , stay tuned for instructions in your email.   *
PAYMENT OPTIONS:
CONFERENCE REGISTRATION FEES: $75 Early Bird with advanced registration prior to December 2, or $85 if registering between December 2nd and December 11, 2020. (Walk-ins are also welcome).
Ideally, we prefer if you use Purple Pass as an option.

TO PAY WITH A CREDIT CARD, please go to: www.purplepass.com/traumaStrategies
TO PAY WITH A CHECK, please send payable to CAEOP to: Chrystie Cruz, CAEOP Treasurer, 126 Park Avenue, Wahlstrom Library, Room 519,  Bridgeport, CT  06604,                                

QUESTIONS?? Contact David Johnston at: educationrwe2@gmail.com, or via phone at: 203.640.6201.

PLEASE ALLOW THE SYSTEM TO SEND YOU A COPY OF THE FORM BELOW FOR YOUR RECORDS. EVERYONE MUST REGISTER HERE FOR OUR RECORDS and make payment either with PurplePass or via snail mail. THANK YOU!!!!

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