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Application Submission

Personal Information
Contact Information :*
Prefix First Middle Last
Organizer ( Materials will be shipped to this address )
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
More information if needed.
Application
Starting Date
Month
Day
Year
Training Information*
$1 Spam Stop
Level:
- Basic
- Advanced
- Certification
- Practicum Supervisor Training Level 1
- Practicum Supervisor Endorsement Level II
- Basic Instructor Training Level I
- Basic Instructor Endorsement Level II
Extra Options:
- Select Option
- SAVE $550 Bonus #1 WHOLE ENCHILADA Including Certification Value of $750 now for ONLY
- SAVE $250 Bonus #2 Basic Intensive plus basic practice [basic Practicum]
- SAVE $250 Bonus #3 Advanced Intensive plus advanced practice [Advanced Practicum]
Total
$ 0.00 CAD
Payment
Credit Card*
Card Details
Cardholder Name
Agreement : I will follow what is outlined in the GLASSER CANADA & WGI Policies and Procedures Manual (PPM), and am aware of the current acceptable intensive training forms and their terms.
- I Agree* i certify that all information is correct.