Event Reservation Form You are registering for: Important: Important: This event is for healthcare professionals only. If you are a patient seeking DBT therapy or other services, please connect with us by visiting our website at tpwg.ca/connect/. Yes, I am a healthcare professional.(Required) I agree Your Name(Required) First Name Last name Your Email(Required) Phone(Required)What is your professional designation within the healthcare field? (e.g., Psychotherapist, Social Worker, Medical Student, etc.)" Reservation and Payment InformationPlease note that your spot is confirmed once payment is received. After submitting this form, please follow the link provided to set up a credit card payment profile with our clinic. This will be used to process payment for the workshop and any further services you may wish to pursue. If you already have a credit card on file with us, please check the box below to provide consent for us to charge this card for your workshop attendance. Should you wish to pay via e-transfer, please send this to intake@tpwg.ca along with the submission of this form in order to secure your space. Payment preference:(Required) I already have a payment profile set up with TPWG and authorize you to charge my card for this workshop attendance I will set up a new payment profile (link on next page) I understand my reservation is only confirmed after payment is arranged.(Required) I agree Please note that the link to the webinar will be emailed to you on the day of the event. Please note that the early bird rate ($400) is available to registrants only until December 10th. Eligible students can be offered the training at a reduced rate ($250); please specify above. If you have any questions please don't hesitate to contact us at intake@tpwg.ca. Thank you!
