 | PFTI THE PARSONS-FEIN TRAINING INSTITUTE FOR PSYCHOTHERAPY AND HYPNOSIS Unique Certification Training Programs for Professionals 275 Central Park West at 88th Street 4B New York, NY 10024 TEL 212 873 4557 FAX 212 874 3271 janeparsons@pfti.org |
| "Few training programs really work with the person of the therapist." - Virginia Satir | PFTI Training Registration | "Develop your own technique; be your own natural self." - Milton H. Erickson, MD |
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Registration for Course No. (and Day/Hour for Courses II and III) ____________________ Fee _______
Today’s Date ____________________
Last Name ___________________________ First Name _________________________ Middle Initial _____
Street Address ___________________________________
City ___________________________________
Phones: Day _________________ Evening ______________ Cell ______________ Fax ________________ License Number ____________ Major Degree _____________ Field of Practice_______________________ Please add any additional comments, if desired, on the reverse of these pages. 1. How I learned about your Training Program:____________________________________________________________________________________________
2. My educational background and graduate degrees: ____________________________________________________________________________________________
3. The context in which I am presently working: Practice (independent, agency, hospital, etc.): ____________________________________________________________________________________________ ____________________________________________________________________________________________
4. Theoretical orientation: ____________________________________________________________________________________________ ____________________________________________________________________________________________
5. Theoretical approach: ____________________________________________________________________________________________ ____________________________________________________________________________________________
6. My additional study/workshops in psychotherapy and hypnosis; and couples work: ____________________________________________________________________________________________ ____________________________________________________________________________________________
7. My experience in the practice of psychotherapy: ____________________________________________________________________________________________ ____________________________________________________________________________________________
8. My experience in the practice of hypnosis and of Ericksonian hypnosis: ____________________________________________________________________________________________ ____________________________________________________________________________________________
9. What I want from this Training: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
10. How I will know I have succeeded in what I want to learn: ____________________________________________________________________________________________ ____________________________________________________________________________________________ |