Printable Seminar Registration Form - Advanced Psychological Anatomy

Registration Form  
Name:
Address:



 
City:
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Country:
Phone:
W: H: C:
Fax:
Profession:
Email Address:
Date of Class:
City of Class
 
Tuition Payment Schedule
$1350 Total Psychological Anatomy tuition to be paid as follows: $450 course deposit followed by $450 on Nov 15, 2008 and $450 on Dec 15, 2008.
 
The Fine Print
Cancellation Policy: Course fees are non-refundable if cancellation occurs within 60 days of scheduled course. Course fee is also non-transferable. If cancellation occurs outside of 60 days, a full tuition refund will be issued less a $75 administration fee.
 
Payment method: Visa ______   Mastercard ______   Cheque # ______
Please make cheques payable to the CFTRE.
Credit Card #:
Expiration Date:
Name on Card:
Signature:
I agree to have the credit card listed above billed for all tuition payments for this course on the dates listed. I also acknowledge that I have read and agree to the course cancellation policy.
Signed _____________________________________________________________________
 
   
CFTRE Mailing Address
Canadian Foundation for Trauma Research & Education, Inc.
1488 West Hastings St
Vancouver, BC
V6G 3J6
CFTRE Fax Number
1-604-694-0086

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