PLEASE PRINT
| description | cost | amount enclosed |
balance owing |
date and location |
|---|---|---|---|---|
| A Safe Passage- Advanced Practitioner Training |
$225.00 |
|
||
| early registration - A Safe Passage- Advanced Practitioner Training |
$200.00 |
|
||
| certification package with workshop discount |
$50.00 | |||
| certification package without discount |
$65.00 | |||
| certification evaluation fee | $50.00 | |||
| distance education mentorship program | $350.00 | |||
| distance course ASP-010 | $25.00 | |||
| distance course ASP-020 | $100.00 | |||
| distance course ASP-030 | $75.00 | |||
| distance course ASP-040 | $100.00 | |||
| distance course ASP-050 | $50.00 | |||
| distance course ASP-060 | $100.00 | |||
| distance course ASP-070 | $100.00 | |||
| distance course ASP-080 | $50.00 | |||
| Totals |
Name: ___________________________
Address:__________________________
City:_____________________________
Postal code:_______________________
Phone:___________________________
Email:____________________________
Dietary requirements: (e.g. vegetarian,...):
________________________________
________________________________
PLEASE MAIL COMPLETED FORM to:
A Safe Passage
20 Weston St
London ON N6C 1R1
Canada
Fees include materials and certificate of completion.
Teaching aids and continuing education supplies will be available for purchase.
Either full payment or a non-refundable deposit of $100 is required with registration.
A charge of $20 will apply to all NSF returned cheques.