Seminar Agreement - Trauma Wise Therapy

Monthly Seminar Participant Agreement

Name *

First

Last

Email *

Business Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Degree *

License Type *

License Number & Jurisdiction (state or province) *

Participant Agreement *

Please check here to confirm your agreement.

I agree that I will not record any portion of the training due to patient confidentiality and that doing so would violate the ethical standards of my profession.

You can make payment via Zelle (US only), PayPal, or Venmo using the links below. Please make sure to put your name in the memo section. Please tell me if you are a student, a clinician serving low-income and/or marginalized populations, or a clinician working in communities where session fees average $60 or below and would like to request a reduced rate.

Venmo

PayPal