Strengthening Families, Building Communities, Developing Minds

Registration – Dominica, Understanding Trauma for Children & Adolescence I

Dominica, Training 2 – Understanding Trauma for Children & Adolescence I

Programme Information

Dates: 9th - 11th December, 2015

Venue: TBA

Time: 8:00 a.m. – 4:00 p.m. (Daily)

Personal Information

First Name:

Surname:

Job Position Title:

Mailing Address:

Email:

Gender: [radio* gender "Male" "Female"]

Date of Birth:


Telephone Numbers

Work:
Ext:

Home:

Mobile:

Facsimile: N/A


Company Information

Company:

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Contact Person:


Personal Considerations
(Dietary:  Chicken Fish Vegetarian) Physical Other


Financial Information

All Payments can be made to: Dominica Coalition of Services Industries, DEXIA Building, Bayfront, Roseau, Dominica

Preferred Payment:

  • Please be advised the cost per workshop is $200.00 EC
  • Payments may be made Via Cheque, Cash
  • All payments (Cheque, or Cash) or proof of payments (copy of the direct deposit slip) must be scanned and emailed to tchdtraining@livelifewelltt.org or thecentre@livelifewelltt.org or by fax: 1 (868) 623 - 6529


Declaration

Authorized Personnel

Date:

Applicant’s Signature:


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For additional details, please contact: Marketing Department at: 1 (868) 224 - 3581/1(868) 221-9273/1 (868) 374-9996/1(868) 374-9814