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, SRT training sessions and supervision 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 10 Group or Individual Supervisions are required for completion of the Foundation Level training; the costs are in addition to tuition fees. It is required that 5 of 10 SRT sessions will be completed by the end of Foundation III.

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.

Registration Form

Name:
Address:
City:
Postal/Zip Code:
Country:
Phone:
W: H: C:
Fax:
Profession:
Email Address:

Date of first

Foundation Class:

City of

Foundation Class:

Tuition Payment Schedule
$2175 Total SRT tuition ($725 per weekend) to be paid as follows: $725 registration deposit with balance of $1450 due 30 days prior to first 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: Security Code: 
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.

Suite 207

346 Lawrence Avenue

Kelowna, BC

V1Y 6L4

CFTRE Phone Numbers

1-250-860-8860

1-888-960-8860 Toll Free

CFTRE Fax Number

1-250-860-8863