Group Crisis Intervention (CISM)

May 16 - 17, 2024

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* These fields are required

1 Your Contact Info

First Name *

Last Name *

Email *

Confirm Email Address *

Cell Phone *

REQUIRED FORMAT: 000-000-0000

Sorry, but this program only has 12 spaces available. You cannot add more people. Try a different program or different dates.

$349.00 – Program Price$349.00 $349.00 – Program Price

Additional personnel you list below will receive an email to complete their Registration Details.

Guest 1		First Name* Last Name* Email*
Guest 1		First Name* Last Name* Email*

Agency Name *	Please do not abbreviate.
Your Position *	(e.g.) Deputy, Police Officer, Detective, Social Worker, Sergeant, Dispatcher, etc...
Address 1	Example: 405 Main Street (Avenue, Lane, Circle, Trail, etc...)
Address 2	Example: Apt 8, Suite 405, Unit 10, etc...
City/Town
State/US Territory
Zip Code

This section pertains to this specific transaction today (paying or not paying)

Answer YES if you are registering and NOT paying today.

Answer NO if you are registering and paying with a Credit Card today.

Is your agency funding this training and paying on a later date? *	If your agency requires you pay for this program and later seek reimbursement from them, select 'No'.
Dept. Billing Contact: NAME *
Dept. Billing Contact: PHONE # *	REQUIRED FORMAT: 000-000-0000
Dept. Billing Contact: EMAIL *
Payment for Courses *	I read and understand the Pricing and Refund Guidelines linked belowPricing and Refund Guidelines

Sub Total	$0

Taxes	$0

Due Now	$0 $0

Choose Payment Option

	We will email a statement to the Billing Contact you provided. Click on the button below and these instructions will be repeated on the next page.

	You will be asked for credit card details in the next step. Click the button below to continue.