• Administrators
• Case managers
• Child life specialists
• Counselors
• Crisis managers
• Elders
• Nurse practitioners
• Occupational therapists
• Professionals working in the field of suicide intervention & prevention
• Physicians
• Program directors
• Psychologists
• Registered nurses
• Public school teachers
• Service coordinators
• Social workers
• Special educators
• Youth workers
• You!

Click here to download the Registration Form. You can then fax or email it to us.You can also call to register and pay by credit card.

We accept Visa, Mastercard, checks and cash.

REGISTRATION  & PAYMENT INFORMATION

Complete the Registration Form (OR print this page) and fax, email, or mail it to us. If you wish to pay by credit card, you can either include the card information on the form or call us and we can process your registration and fee over the phone.

WORKSHOP FEE

                     $750.00 + GST ($787.50)

REGISTRANT'S NAME: ____________________________________

TITLE:__________________________________________________

ORGANIZATION:__________________________________________

ADDRESS:_______________________________________________

________________________________________________________

PHONE:__________________________FAX:____________________

EMAIL: ­­­­­­­­­­­­­­­­­__________________________________________________

ADDITIONAL REGISTRANTS:_________________________________

________________________________________________________

________________________________________________________

TOTAL AMOUNT: _______________

Check enclosed (Payable W. Zarchikoff & Associates) ______

Check will be mailed  ________

Person responsible for payment: ______________________________

PO Number:______________________________________________

Please charge my ______Visa _____Mastercard

Card #__________________________________________________

Exp____________________

Cardholder___________________________________Date______________________

Signature___________________________

If you prefer, you can call us to pay by credit card.

Please mail, fax or email registration forms to:

W. Zarchikoff & Associates
19899 - 55A Avenue, Suite 112
Langley, BC
V3A 0C4

Phone: (604) 970 – 3419 or Toll-Free: 1-888-683-7711

Fax: (604) 530-3841

Email: wzarchikoff@yahoo.com