Peer and Trauma Support Services – Peer Support Training Registration

PATSS Registration Form

Registration for the 2-Day Peer Support Training via Zoom.

Which course are you registering for?(Required)

How many people are you registering?(Required)

Registrant Name:(Required)

First Last

Registrant Phone:(Required)

Registrant Email:(Required)

Organization:

2nd Registrant Name:(Required)

First Last

2nd Registrant Phone:(Required)

2nd Registrant Email:(Required)

2nd Registrant's Organization:

3rd Registrant Name:(Required)

First Last

3rd Registrant Phone:(Required)

3rd Registrant Email:(Required)

3rd Registrant's Organization:

4th Registrant Name:(Required)

First Last

4th Registrant Phone:(Required)

4th Registrant Email:(Required)

4th Registrant's Organization:

Payment Made By:(Required)

First Last

Payers Phone Number:(Required)

Payers Email:(Required)

Total:

Price: $ 0.00 CAD

Payment Method(Required)

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name