Event Reservation Form You are registering for:Your Name(Required) First Name Last name Your Email(Required) Phone(Required)What kind of health provider are you? (i.e. Psychotherapist, Psychologist, R.S.W etc.)Do you have any questions or topics you are hoping to learn in the workshop?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)(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)(Required) I agree A copy of your registration form will be emailed to you. Once payment is received, you will be added to the list for this workshop. The link to the workshop will be emailed to you on the day of the event. If you have any questions please don't hesitate to contact us at intake@tpwg.ca. Thank you!
