Workshop/Training Registration Form:
Workshop/Training Title:
Workshop Dates:
First Name
Last Name
Street
City
State
Zip
Email
Phone
Handicap Accommodations Assistance Needed? Offer details in the comment area.
no
yes
not sure
CE credits?
no
yes
Agree with the cancellation/refund policy?
yes
no
not sure
Payment Method
(we will send you a paypal invoice if you select Paypal)
send check
Paypal
Please describe briefly prior training in core concepts and practices of PS
Please bring to our attention any conditions you may have that may affect your participation in the training program such as current health status, psychiatric conditions, major stressors.
Agree with confidentiality policy and video release agreement?
no
yes
not sure
Questions, comments?
last updated: 2/2/12