ACT Webinar Registration Form

Webinar Registration Form

Please complete the form below to register for one place on the ACT Taster Session Webinar. Please fill out all sections and we'll get back to you with full confirmation of your space. You can choose which date and time you wish to book below.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Phone Number

Area CodePhone Number
Attendee e-mail address
example@example.com
If joining confirmation is to be sent to a different email address
example@example.com
By joining this webinar you are agreeing to receive emails from Koala Counselling in relation to the topics being presented in the webinar. You can unsubscribe at any time to these emails by choosing unsubscribe at the bottom of any email received. For more info and to read our T&Cs please go to: https://koalacounselling.com/
Which webinar date in JULY do you wish to attend? *

MonthDayYear
Choose one of two dates in JULY
How did you hear about us?*
Any further information you wish to tell us about your counselling experience
Pay for your place on the webinar*
prevnext( X )
Book your place on the webinar Please pay via PayPal by clicking BOOK MY PLACE below and select the PayPal, Debit Card or Credit Card option' on the cart screen. Price for one attendee to join the webinar for ACT Training with Koala Counselling.
£12.00 Quantity

Total

£0.00
Please verify that you are human*
A confirmation email will be forwarded on receipt of payment. If you don't receive a response from us within 3 working days, please check your spam or junk mail folder. Otherwise, do please email us: mail@koalacounselling.com
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