EmailMe Form - ACT Facilitator Workshop Registration

ACT Facilitator Workshop Registration

Training for professionals working with families of young children to teach the ACT Raising Safe Kids curriculum in their communities.

Name
First Last
Organization
Position Title
Email
Address (If requesting that we bill your organization, please provide organization's Billing Address here)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone
### - ### - ####
Please select your training dates.
June 3-4, 2013
Approximately how many workshops for adults have you led?
0
1-10
10-25
25+
Approximately how many workshops for parents have you led?
0
1-10
10-25
25+
Have you taught or guest lectured an academic course?
Yes
No
How did you hear about us?
Online Ad
Print Ad
Email
Colleague
Website
Other
Registration: $195
Please bill my organization
I will mail my check
I will bring my check with me
I will call the Center to pay via credit card
Please make checks payable to:
ACT Northeast Regional Training Center
Brandeis University, MS 044
415 South Street
Waltham, MA 02454

If you prefer to pay via credit card, please call our office at 781.736.2200 to provide your credit card information.

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