ANewPlace: Offices of Kevin Barwick

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PTI Registration

To ensure your space and order your manuals, please complete the registration form below and press submit. Then please make a deposit of $75/person. You can use your credit card via PayPal. Your balance of $215 per person is due on the first day of class (total cost for PTI Weekend is $290/person, or $19/hr/person). Checks should be made payable to Anew Place.

Dates of PTI

Participant 1

First and Last Name
Address
City
State	Zip Code
Daytime Phone
Evening Phone
Email
Payment Amount

Participant 2

First and Last Name
Address
City
State	Zip Code
Daytime Phone
Evening Phone
Email
Payment Amount

Kevin Barwick, LCPC, MHt
6944 Nashville Road
Lanham, MD 20706
301-552-6688 (office)
301-552-8904 (fax)
KevinBarwick@AnewPlace.info

Kevin Barwick, LCPC, MHt
6944 Nashville Road, Lanham, MD 20706
301-552-6688 (office) 301-552-8904 (fax)