Advanced Specialist Certification Form

Advanced Grief Recovery Specialist Training

Participant Registration Form
Title
Name: *

First Name Last Name
Name on Certificate *
Date of Certification Completion

Month Day Year
Date
Location of original Certification Training
Company
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Please re-enter the email address *
example@example.com
Phone Number *
Date of Training

September 2, 3 & 4 2020 December 2, 3 & 4 2020 March 10, 11, & 12 2021 May 12, 13 & 14 2021 July 7, 8, & 9 2021 September 8, 9 & 10 2021 November 10, 11 & 12 2021
Training Times

The training will take place via Zoom (meeting ID will be provided once you have registered for the training) from 5:30-7:30 pm AWST (Perth, Western Australia time)
Payment Method

Please read the payment options below carefully and choose the one that applies.
Payment Options *
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Advanced Certification Full Payment ( $ 1,800.00 AUD one-time payment)

Advanced Certification - 2 Payments ($2000) ( $ 1,000.00 AUD for each month )

Advanced Certification - 4 Payments ($2000) ( $ 500.00 AUD for each month )

Advanced Certification - 5 Payments ($2000) ( $ 400.00 AUD for each month )

Advanced Certification - 8 Payments ($2000) ( $ 250.00 AUD for each month )

Advanced Certification - 10 Payments ($2000) ( $ 200.00 AUD for each month )
Should be Empty:

Advanced Grief Recovery Specialist Training