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 ANXIETY Powered By Docstoc
					             Registration Form
             (Duplicate this form if necessary.)
      Register me for the following workshop:
       r Anxiety: An Inconspicuous
         Classroom Bully
             Thursday October 21, 2010                                                                                          HACC’s LANCASTER CAMPUS PRESENTS
             6:00 – 9:00 p.m.

                                                                                                                            CLASSROOM SUPPORT FOR STUDENTS

State                               Zip
Phone                               Email

Registration Fee:
–––––––    Single registrant $25.00
–––––––    3 or more registering together from the
           same school $20.00 each registrant

Method of Payment:
o Check enclosed - payable to HACC

                                                                   HACC does not discriminate in employment,
o Visa                                                             student admissions, and student services on
o MasterCard                                                       the basis of race, color, religion, age, political
                                                                   affiliation or belief, sex, national origin,
                                                                                                                        AN INCONSPICUOUS
Credit Card#                        Exp. Date                      ancestry, disability, place of birth, General
                                                                   Education Development Certification (GED),
––––––––––––––––––––––––––––––––––––––––––––––––––                 marital status, sexual orientation, gender
Name on Card
                                                                   identity or expression, veteran status, or           CLASSROOM BULLY
Authorized Signature                                               any other legally protected classification.          _______________

Are there other topics that you would be interested in having us
offer? Please indicate possible topics/dates/presenters below.                                                          Counselor Workshop
                                                                                                                        Series Session #1
––––––––––––––––––––––––––––––––––––––––––––––––––                                                                      ACT 48 APPROVED NBCC APPROVED

Tear off this registration form and send to:
    HACC -- Lancaster Campus
    1641 Old Philadelphia Pike
    Lancaster, PA 17602
    Attn: Peggy Andrews
                                   Workshop Series
                                                   WORKSHOP #1

                ANXIETY:                          ANXIETY:
                                           AN INCONSPICUOUS
An Inconspicuous Classroom Bully           CLASSROOM BULLY
                                    This workshop will provide a user-friendly focus
                                      on anxiety and its impact on the classroom.

                                        Thursday, October 21, 2010                     Mark your Calendar!
                                             6:00 - 9:00 pm
                                        HACC’s Lancaster Campus
                                         Main Building Room 222                          March 24 and June 15
                                               Daniel J. Pezzulo, Ph.D                     are the scheduled
                                        School Psychologist & Psychotherapist
                                         Behavioral Health Care Consultants
                                                                                         dates for the next two
                                                                                       Counselor Workshop Series.
                                           TOPICS TO INCLUDE:

                                       n    Neurological, biological and
                                            psychological components
                                            of anxiety
                                       n    Types of anxiety and the
                                            resulting impact upon the
                                            individual and the entire
                                       n    Strategies for treating
                                            and coping with anxiety
                                              Refreshments will be served.