Traumatic Incident Reduction (TIR)
  Workskop Registration Form

 

Traumatic Incident Reduction (TIR) Training

Registration Form

Please use this Registration Form for Ragnhild Malnati's Traumatic Incident Reduction Workshops in the Washington, D.C. Metropolitan Area. For workshops in other locations, please use our Enquiry Form.

Please print this form and mail or fax to:

Ragnhild Malnati, LCSW-C
Personal Enhancement Center
1003 Crest Park Drive
Silver Spring, MD   20903

Phone & Fax: 301-445-6444
Email: raggi@comcast.net

 

Name:                _____________________________________________

Address:             ____________________________________________

City, State, Zip:    _____________________________________________

 

Telephones & Other Contact Numbers:

Office:  __________________________

Home:  __________________________

Fax:     __________________________

Email: __________________________

 

Indicate your choice of 2003 workshops below.

______ June 19, 20, 21, 22
______ July 17, 18, 19, 20
______ July 31 & Aug 1-3

 

Registration deposit $100.00 (Enclosed)____________________

Early Registration Discount: $530.00_______________________(If paid one month before seminar)

Full Tuition: $550.00___________________________________(Due: two weeks before seminar)

Partner Discount: $50.00 ______________________________

Partner's Name: ___________________________________

 

Credit Card Type:     _______________________

Credit Card Number: _______________________

Expiration Date:       _______________________

Authorized Signature: _______________________

Please make checks payable to: Personal Enhancement Center