Running DBT Skills-Development Groups
Online Live Course Booking Form

Date

Please select the date you would like to attend (please contact us or submit the form again if you would like to make multiple bookings):

-- Please select -- 21-23 Sept 2020 - £320 plus VAT 11-13 Jan 2021 - £320 plus VAT 11-13 May 2021 - £320 plus VAT 11-13 Oct 2021 - £320 plus VAT

Attendee details

Full name:

Tel:

Email:

Postal address (this is where your workbook will be sent to):

Date of Birth:

(Please note, this information will not be shared and is for registration purposes only.)

Billing details

Invoice address (if different from above):

Purchase Order Number (if known):

Further details

Area of specialism (of attendee):

-- Please select -- Adult Mental Health Children and Adolescents Forensic Intellectual Disability Older People Substance Misuse Other

Professional affiliation (of attendee):

-- Please select -- Nursing Occupational Therapy Probation Psychiatry Psychology Social Work Teaching Other

How did you hear about this course?

-- Please select -- Brochure/Letter Email Existing Customer Facebook LinkedIn Magazine Advert (The Psychologist) Magazine Advert (CBT Today) Recommendation Search Engine (e.g. Google and Bing) Twitter Other

  I agree to the APT Terms and Conditions.

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