Clone of 2026 Advanced Training Registration Form

2027 COLLABORATIVE INTRODUCTORY TRAINING REGISTRATION FORM
Full Name

First NameLast Name
Organization
Profession:
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are You A Current Member of CPIM?
PAYMENT: To submit your payment, please use one of the following payment links:

NON-CPIM MEMBER EARLY BIRD RATE ($750) valid through 12/15/26 - CLICK HERE TO PAY NON-CPIM MEMBER EB RATE

CPIM MEMBER EARLY BIRD RATE ($700) valid through 12/15/26 - CLICK HERE TO PAY CPIM MEMBER EB RATE

NON-CPIM MEMBER STANDARD RATE ($800) starting 12/16/26 - CLICK HERE TO PAY NON-CPIM MEMBER STANDARD RATE

CPIM MEMBER STANDARD RATE ($750) starting 12/16/26 - CLICK HERE TO PAY CPIM MEMBER STANDARD RATE
CANCELLATION POLICY:

30 days (75% refund), 14 days (50% refund), 7 days (25% refund)

We regret that we cannot honor refund requests within the week before the workshop.
EMAIL AIME VANDERMEER (admin@collaborativepracticemi.org) WITH ANY SPECIAL ARRANGEMENTS OR DIETARY RESTRICTIONS
Should be Empty:

2027 COLLABORATIVE INTRODUCTORY TRAINING REGISTRATION FORM