Request to Register
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
Confirmation Email
example@example.com
Back
Next
What would you like to Register for
*
Recovery Coach Course $2000
Recovery Coach Supervised Practicum $1000
Recovery Coach Skills for Organizations $TBA - We will connect with you
Recovery Coach for Health Professionals $TBA - We will connect with you
Select class for Recovery Coach $2000+tax
*
Jan 20, 2025 - Feb 26,2025 - Zoom - Mon & Wed 5:30pm - 8:30pm PST
Recovery Coach Supervised Practicum $1000+tax
*
TBA
Will you be paying for your course, or has your employer/alternative party arranged to forward payment?
*
I am paying
Employer or 3rd party will forward you payment
Name of who is forwarding this payment?
Where should we email the invoice to?
example@example.com
Any additional notes or comments for us?
Submit
Should be Empty: