20.06.2016 Therapiezentrum Glückspilze, Am Gierath 20 D, 40885 Ratingen, Germany (next airport: Düsseldorf DUS, 15 minutes from workshop location) Teaching Functional Living Skills English Participant 89,00 EUR Member of „ABA Deutschland“ 79,00 EUR Parents of children who receive service by „THZ Glückspilze“ 69,00 EUR ! Please write in block letters ! 1. surname, name: 2. surname, name: __________________________________________ ____________________________________________ Adress: street, postal code, town and country of residence: Adress: street, postal code, town and country of residence: __________________________________________ ____________________________________________ Phone and E-Mail: Phone and E-Mail: __________________________________________ ____________________________________________ CEs for BCBA/BCaBA desired? CEs for BCBA/BCaBA desired? [ [ Number of participants: _____________ Yes [ No No [ Yes total costs: _______________ The number of participants will be limited. Therefore we recommend to send this document back to us filled in and signed, as soon as possible. As we receive your registration we will send you a confirmation mail containing our bank details. _______________________________________ _____________________________________ place, date signature Am Löken Nr. 11, 40885 Ratingen, Telefon: 02102/1026650, E-Mail: [email protected], www.glueckspilze-ratingen.de