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Ian Macnaughton & Associates Inc.
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EOTN 1 - Vancouver 2024 Registration
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First name
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Last name
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Email
Title
Mr
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Phone Number
Alternate Contact Number
Preferred Personal Pronoun
They/them/theirs
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Home Address
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City / Province / Postal Code /Zip
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Country
Level of Education - Please choose all that apply
BA/BSc
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If other is selected please specify
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Licence#
Disability Status: Do you have a disability as defined by the Accessible Canada Act?
Yes
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If yes, please let us know of any accommodations we can make to best support your learning process
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What is your current profession? Include any area of specialization.
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Where and when will/have you complete(d) the SEI Advanced 1 Training?
I've had a major traumatically-stressing event within the past year
Yes
I understand that the SE Training may trigger past traumas.
Yes
Are there any grievances, complaints, or actions pending or upheld against you for misconduct as a professional by any licensing, regulating, or associate body?
Yes
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If Yes, please provide details and relevant information you are legally permitted to disclose here:
*
Do you have any anaphylactic food allergies? If so please list them.
Anything we should know?
SUBMIT
SE™ Master Class: Eye of the Needle (EOTN) - Part 1
May 16, 2024, 10:00 AM PDT – May 20, 2024, 6:00 PM PDT
Polish Friendship ZGODA Society
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