DBT Institute of Michigan Training Registration

Online Training Registration
Name:

First NameLast Name
Title
Credentials
Professional License Number
Company
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Participant E-mail
Work Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
May we send you future training email notifications?
Dietary Needs:

Other
Training Available

Select the training(s) you wish to register for. Please select "early bird pricing" if you are registering 30 days before the training date.

Adolescent and Family DBT$550.00

RatesDate

Core DBT Training$1,500.00

RatesDate

Enter coupon

Total $0.00

Receipt E-mail, if different than the participant
example@example.com
There are no cancellations or substitutions available and tuition is non-refundable.

After clicking the "submit" button you'll be redirected to PayPal's website to submit payment. If you don't have an account don't worrry, you can still submit a payment with a credit card.

Please email hannah@dbtimi.com with any questions.
If registering as a student, upload a copy of your college photo ID.

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