Workshop Registration

Workshop Registration Please complete this form and submit it to the TIR Institute of Maine.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Please SELECT your preferred WORKSHOP DATE *

TIR Workshop May 31-June 3, 2019

PAYMENT SELECTION *

TIR Workshop: Check or money order for $597 ($547 if paid-in-full 30 days prior to start of workshop) LSR Workshop: Check or money order for $597 ($547 if paid in full 30 days prior to start of workshop) TIR-EA Workshop: Check or money order for $597 ($547 if paid-in-full 30 days prior to workshop) ANY Workshop payment made by Credit Card or PayPal choose link below OTHER Please explain below

Other Payment Information *

Please write out your check or money order to: TIR Institute of Maine and send to:
TIR Institute of Maine
PO Box 2
Smithfield, ME 04978

SUBMIT or PRINT ( to mail )

SUBMIT

Crown Cove Counseling office is located at 28 Merry Lane in Smithfield, Maine