TEST RMC TTT FORM RM-TTT and RMC Select Course(Required)Train the Trainer Course (TTT)Resilient Minds Course (RMC)Select a date(Required) November 14-16, 20, 9:00 am to 3:00 pm EST – Virtual Request a CLOSED TTT Select a date(Required)** October 21st, 8:30 am to 4:30 pm – Virtual (SOLD OUT) Request a CLOSED RMC Name(Required) First Last PhoneEmail(Required) Fire Department(Required) Fire Department Other Name of Fire Hall(Required) Other(Required) Position/Title(Required) Mailing Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Participants you are registering(Required) Myself Participants: List all participants (name and email) Will provide complete list later *for closed dates, a minimum number of 12 participants is requiredParticipants you are registering(Required) Myself Participants: List all participants (name and email) Will provide complete list later *for closed dates a minimum number of 15 participants is requiredList all participant(s): name and email(Required)Full NameEmail Address Add RemoveDo participants have experience in adult education and/or training with instruction? Not much A little Some Quite a bit A lot Do participants have a general understanding of mental health and/or trauma? Not much A little Some Quite a bit A lot Have participants been involved with a Critical Incident Stress Management/Peer Support Team? Yes No How did you hear about the Resilient Minds program? Word of mouth Website Social media Newsletter Other Other Please select:(Required) Pay now - Paypal or credit card Request an invoice (NOTE: Payment by invoice is available to Fire Departments only. Individual registrants must pre-pay by PayPal)Organization Name(Required) Contact(Required) Address(Required) Street Address Address Line 2 City Province Postal Code Phone(Required)Special discounted price:($275 per participant)(Required) Price: Number of participants(Required)Number of participants (Invoice)(Required)Total (Invoice)Please select:(Required) Pay now - Paypal or credit card Request an invoice (NOTE: Payment by invoice is available to Fire Departments only. Individual registrants must pre-pay by PayPal)Organization Name(Required) Contact(Required) Address(Required) Street Address Address Line 2 City Province Postal Code Phone(Required)Regular price: $75 per participant(Required) Price: Number of participants (Invoice)(Required)Number of participants(Required)Total (Invoice)Total Payment Method * RequiredPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Anything else we should know?HiddenSurvey participation(Required) By accessing this special price, I agree to participate in all pre and post workshop surveys. I understand participation in surveys are mandatory and anonymous.*CMHA has the right to cancel seven business days before the start date of the workshop. As such, participants can re-register or receive credit for their seat. Full refunds can be provided if cancelled thereafter.** If you selected "Pay Now" you can still use your credit card without a Paypal account. Proceed to Paypal and choose "Pay with credit or Visa/Debit card."CommentsThis field is for validation purposes and should be left unchanged.
