traumatic incident reduction

TRAUMATIC INCIDENT REDUCTION (TIR)

TIR ENQUIRY FORM

You may use this TIR Enquiry Form to:

Please fill out as much information in the fields below as possible. All information will be held in strictest confidence and your name will not be used for any purpose other than our responding to you in the manner that you request. This form can be submitted to us automatically from your web browser by clicking on the Submit button at the end of the form.

 



Let Us Know How to Contact You:

First Name:
Last Name:
Title:

Other:
Organization (if applicable):
Occupation:

Other:
Street:
City:
State or Province:

Other:
Zip or Postal Code:
Country:
E-Mail Address:
Please enter E-Mail Address again:
Telephone:
Fax:
I prefer to be contacted by:

Other:
PTSD trauma resolution
Let Us Know What You Need:

In what field do you operate?:

Other:
Regarding TIR, in what areas are you interested?:

Other:
Are you currently using TIR in your practice
as a therapist, counsellor or helper?
Yes   No  
Would you like to use TIR in your practice
as a therapist, counsellor or helper?
Yes   No   Possibly
Would you like to enroll in a TIR Training Workshop?: Yes   No   Possibly  
If you answered "yes" to the above question,
please let us know the location and date of the
workshop you wish to attend ( see calendar ):
Location:
Date:
If there is not a workshop scheduled for your
area, would you be interested in bringing a certified
TIR trainer to your venue to conduct a training?
Yes   No   Possibly  
Would you like a certified TIR facilitator near your
area to contact you about working with you -
or with someone you know - to resolve personal
trauma-related issues?
Yes   No   Possibly  
If you answered "yes" or "possibly" to the above
question, please let us know the city and state
or country in which you need this service:
City:
State or Country:
If there is not a certified TIR facilitator in your
area, would you will be willing to travel to the
closest practitioner to receive his/her services?
(See our list of Certified Practitioners)
Yes   No   Possibly  
Would you like to become a member of the
Traumatic Incident Reduction Association (TIRA)?
(See the benefits of TIRA membership)
Yes   No   Already a Member  
PTSD trauma resolution
Give Us Feedback to Help Us Improve Our Services to You

How did you find this website?

Other:
How would you rate this website for
its clarity and quality of information?
How would you rate this website for
accessability and ease of navigation?
How can we improve this site for you?
Additional comments or questions: