ITTM "Online" Training Program ORDER PAGE
Please fill in and submit this Online Registration/Order Form
to commence your order.

FIRST NAME:
SURNAME:
HOME ADDRESS:
CITY/TOWN:
PROVINCE/STATE:
COUNTRY:
HOME PHONE:
CELL PHONE:
EMAIL:

EDUCATION

PROFESSIONAL DEGREE: BA, MA, MSW, PHD., PSY.D., MD., GPP.
(Please list all degrees, credentials, or designations)
OTHER:

EMPLOYER INFORMATION

EMPLOYER NAME/PRIVATE PRACTICE:
ADDRESS OF EMPLOYER OR PRIVATE PRACTICE:
CITY/TOWN:
PROVINCE/STATE:
COUNTRY:
WORK TELEPHONE NUMBER:
POSITION:
YEARS WITH CURRENT EMPLOYER:
Total years of experience in Psychology/Mental Health/Counseling/Health Field/Pastoral Counseling:

OTHER INFORMATION & COMMENTS

  • Please note that registrations are not complete until payment has been received in full.
  • A confirmation and tax invoice will be issued automatically upon registration to your nominated email address.

TOTAL COST OF THE ONLINE ITTM COURSE:

$1,200 USD *All International orders and orders outside of Canada pay in US Dollars.
$1,285 CDN *Canadian orders only - pay in Canadian Dollars.

PLEASE SELECT PAYMENT OPTION BELOW:
(Payment is due upon registration)

Credit Card Payment
We accept Credit Card Payments from anywhere in the world using the safe and secure FreshBooks platform. To pay by credit card, simply tick this box and once your order form is received and processed, an invoice will be emailed to you with a link to payment instructions.
E-Transfer (Canadian Residents only):
Email payment to registration@theittm.com
Etransfer Question:
Etransfer Answer:
Credit Card Payment by Phone
Call +1 519-830-7272 (Ontario, Canada) to place your order by phone.