Printable Seminar Registration Form

Seminar
Self Regulation Therapy® Practitioner Training Foundation Level

The Fine Print
By submitting an application you are making a commitment to attend all classes at the Foundation Level. A course deposit of $725 is due upon acceptance into the training. The remaining tuition of $1450 for the Foundation Level training must be submitted 30 days prior to Foundation I training weekend. A late fee of $100 will be levied on payments received after the tuition deadline.

Tuition is non-refundable if withdrawal is within 30 days of the course start date. If withdrawal is 31-60 days before course start date, a full tuition refund less $350 will be issued. If cancellation occurs outside of 60 days, a full tuition refund will be issued less a $75 administration fee.

Ten SRT training sessions with a qualified SRT practitioner as well as six group supervision sessions are required for completion of the Foundation Level training; the costs are in addition to tuition fees.

Foundation Level classes must be taken in order. Advanced Level classes may only be taken after successful completion of the entire Foundation Level training. A certificate of completion will be issued once all requirements are completed.

Name:
Address:
City:
Postal/Zip Code:
Country:
Phone:	W: H: C:
Fax:
Profession:
Email Address:
Date of first Foundation Class:
City of Foundation Class:

Payment method: Visa ______   Mastercard ______   Cheque # ______
Please make cheques payable to the CFTRE and provide a post-dated cheque for the balance ($1450) dated 30 days prior to the first class.
Credit Card #:
Expiration Date:
Name on Card:
Signature:
Billing
If accepted into this training, I agree to allow the credit card listed here to be charged for all tuition, when that tuition becomes due. I also acknowledge that I have read and agree to the course cancellation policy.
Signed _____________________________________________________________________

Important Instructions
Please complete the registration form, including tuition payment and mail or fax it along with the following:
1. Current resume including professional training, education, and work history.
2. Describe your experience in healing trauma both personally and professionally.
3. How do you hope to use the skills you will learn in this training?

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