Empowered Supervisor: Registration for Clinical SupervisionTraining

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* 1. Please complete the following

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Do you have 2-5 years postgraduate experience in counselling, psychotherapy, clinical social work or a related field? Are you currently supervising? or thinking about starting? Please describe your experiences.

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* 3. Are you registered with a professional association and/or a regulatory body? Please list all professional associations/and or regulatory bodies you belong to:

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* 4. We will meet Fridays from Sept 29th-Oct 27th 2023 from 10am-12pm EST. Are you able to attend all 5 weeks of online group meetings (via zoom)?

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* 5. The course fee is $725. Pay Etransfer to paulineobrienrp@gmail.com or reply with request to pay by CC and I will invoice you a link to pay.
How do you wish to pay?

Etransfer via autodeposit to paulineobrienrp@gmail.com (send etransfer following completing this form)

Credit card (Click link to make payment)

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* 6. How did you hear about this training?