REGISTRATION FORM

Please fill out the following form in order to participate in the course.

Eliciting Trauma, Structure of Addiction & Healing Pathway

I hereby want to apply for the 2-day course titled 'Elicting Trauma, Structure of Addition & Heaing Pathway' scheduled on 22nd& 23rd June 2024.

First name

Last name

Contact No.

Do you have any educaional or professional background in Counselling/Clincal/Psychology?

Yes

What is your highest educational qualification?

What is your current profession?

Which mode would you prefer attending the course?

Online (Zoom)

Offline (Mumbai)

Will decide closer to the date

Your food preference (for offline participants)

Veg

Non-veg

Current Address (for certification)

I hereby acknowledge that I have read and accepted all of the terms and conditions set forth by The Anil Thomas Fellowship.Read Terms & Conditions

Thanks for submitting!

Office no.2, Legends Appt., Vakola, Santacruz E, Mumbai 400 055.

Beyond Programming 101