Printable Seminar Registration Form – Psychological
Anatomy- Kelowna April 25-29, 2012
Registration Form
Name:
Address:
City:
Postal/Zip Code:
Country:
Phone:
W: H: C:
Fax:
Profession:
Email Address:
Date of Class:
City of Class
Tuition Payment Schedule
Total Psychological Anatomy tuition: $975.00 due with submission of registration form
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.
