Education

Course Registration (Step 1 of 3)

* indicates a required field

Families and Addictions Cost: 175.00
Course Date: April 28-129 2010
Course Location: The Pas
Your Name: *
Address: *
City / Town: *
Postal Code: *
E-mail: *
Fax:
Daytime Phone: *
Evening Phone:
   
To pay for your course by Visa or Mastercard, please indicate this on your form. You will be contacted to process the credit card transaction over the telephone.
Method of Payment : *
Note: All cash, cheques and money orders must be mailed or dropped off at the AFM office prior to the start date of the course.
If an invoice needs to be sent to an organization, please complete:
Employer/Sponsor/Company Name:
Contact person's name:
Address:
City:
Postal Code:
Phone number:
   
Have you completed the pre-requisites? Yes:
If yes please specify the last course date:
If yes please specify the last course location:
 
Occupation:
If you have chosen other please specify:
   
Education: *
If you have a degree please specify:
If you have a diploma please specify:
   
Do you have previous education in counselling? Yes:
If yes please specify: * required if you've answered yes above
Do you have previous education in addictions? Yes:
If yes please specify:
Are you taking this course for credit or professional development hours? Yes:
If yes please specify the course:  
ACCP University of Manitoba
Professional Organization
Other educational institution program (Specify)
 
 
Reason for taking this course (check one): *
Personal Interest:
Employment Requirement :
Professional Development :