Registration Form Thank you for your interest in the Fall 2024 Intro to DBT course! The course runs for 12 Mondays from 2pm - 5pm PST via Zoom, starting September 9, 2024. The last class is planned for December 16, 2024. There will be no classes on: September 30, 2024 (National Day for Truth and Reconciliation) October 14, 2024 (Thanksgiving) November 11, 2024 (Remembrance Day) Recordings of this workshop will not be available. Ready to register and pay? Fill in the form below. You will be redirected to PayPal to pay and complete registration. You do not need a PayPal account to pay! Need more information? Visit https://dbtvancouver.com/our-events/fall-2024-intro-to-dbt-course/. Are you part of a group? Groups of 3 or more are eligible for a 10% discount. Groups of 5 or more are eligible for a 15% discount. Email info@dbtvancouver.com for more information and to get a discount code. Group discounts must be organized before registration, i.e., can not be made retroactively. Students are not eligible for group discounts. Questions? Email info@dbtvancouver.com or call Jen (DBTCV office manager) at 604-569-1156 during regular business hours.RM_StatsParticipant InformationFirst name *Last name *At the end of the course, participants will receive a letter of attendance confirming the number of credits awarded. Please indicate below how you would like your name to be listed on the letter.Name on letter of attendanceEmail *Enter email again *Receipt and CE letter will go to this email address.Phone Number *PronounsCity of residenceProvince/StateCountry (if outside of Canada or US)OrganizationProfession * Current grad student (Masters / Doctorate) Case Manager Social Worker (MSW / RSW / Ph.d) Counsellor (MA., MC., M.Sc., M.Ed.) Doctoral clinician (working towards registration) Psychologist (Ph.D., Psy.D.) Psychiatrist / MD Other (please enter)Please check all that apply 1. Describe your educational background related to mental healthFor e.g., Current student in Master of Arts Counselling Psychology program at UBC / Psy.D. in Clinical Psychology from Adler / Psychiatrist resident, etc2. What clinical settings do you work in? (Check all that apply.) * Private solo practice Private group practice Hospital in-patient Hospital out-patient Community health Forensic setting Residential treatment Other3. What other treatment modalities do you use / have used in your clinical practice?4. Do you have any previous DBT training? * I’ve attended some workshops. I’ve done some self-study. I’ve observed some DBT groups. Other5. What interests you about this course and what are some of your goals or expectations for the training? 6. How did you hear of this course? * Friend / Colleague School Google/ web search BC Psychological Association I am on your email list Other 7. Is there anything else you would like us to know about you or that you would like to add? (Optional) PaymentEarly Bird registration (April, 2024 – August 5, 2024) Professional: $1375 + $68.75 (GST) = $1443.75* Student: $945 + $47.25 (GST) = $992.25* * Instalment option available (25% of course fee). Payment is due in full prior to the start of the course.Regular registration (August 6, 2024 – September 6, 2024) Professional: $1510+ $75.50 (GST) = $1585.50 Student: $1045 + $52.25 (GST) = $1097.25 Cancellation policy * I understand DBTCV will provide a refund (minus $150 administrative fee) up to 6 days prior to the start of the session. Refunds will not be provided after Monday, September 2, 2024. No recordings * I understand if I am not able to attend a class, a recording of the class will not be available. Select your type of registrationSelect an optionProfessional (Intro Class - Full payment - Early Bird) ($ 1375)Student (Intro Class - Full payment - Early Bird) ($ 945)Professional (Intro Class - Instalment - Early Bird) ($ 343.75)Student (Intro Class - Instalment - Early Bird) ($ 236.25)After you click Submit, you will be redirected to the PayPal website to complete your payment for this course. An email confirmation will be sent to the email address you provided. Don't have a PayPal account? Not to worry! You can use a debit or credit cart to complete purchase.Notes for AdminSelect a payment method * Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
