2020 Registration Flyer

Only 9 training slots are available in any of these trainings.


Total Registration Fee is: $1,300.00 (includes 40 CE's for Social Work, Counselor, & Psychologist; 6 days of

                                                                training, & 10 hours of consultation)

Check or Money Order Accepted & Made Payable to: TBFVA, Inc.


You must complete this flyer & return with your 1st half of your payment ($650.00) to reserve you training slot: 

                                                              TBFVA, Inc.

                                                              2429 Gammons Creek Dr.

                                                              Maidens, VA 23102 

Balance of Fee is due on Day 1 of Training

To receive the entire Registration Information packet, email: tbf2inc@gmail.com



Schedule: Check the dates you plan to attend. All Times are 8:30am - 4:30pm EST.

_____     Part 1:  7/10, 11, 12/2020      &     Part 2:   8/21, 22, 23/2020

_____    Part 1:  9/16, 17, 18/2020      &     Part 2:    10/28, 29, 30/2020

_____    Part 1:  11/18, 19, 20/2020    &     Part 2:     1/6, 7, 8/2021


Please PRINT: Be sure everything is readable.


Name:________________________________________           Address:_____________________________________

Email:________________________________ Cell #: (   ___  )________________   City:_______________________

State:______ Zip:________


Type of License:_________________ #:__________________________        State Licensed In:__________________


If Intern, Name of Supervisor:______________________________________ 


               License Type/Number:_____________________________________ 

                                                       (include letter from them stating their role of supervision, their approval to take

                                                        training, their license type and number)        


Type of CE Certificate: LCSW____   LPC____   Psychologist____




*NOTE: All of the information below is provided in the Registration Information Packet

I have read & understand that this training is provided virtually on Zoom.us:____(Initial)


I understand that I must have a computer or laptop with internet access:____(Initial)


I have read & understand the consultation requirement:____ (Initial)


I have read & understand the cancellation policy: ____ (Initial)


I have read & understand the recommendation to not participate in this training if pregnant:____(Initial)


I have read & agree to the Notice of Disclosure:    Signature:_____________________________________________


Address: 2429 Gammons Creek Dr.

               Maidens, VA 23102


Phone:    (614) 507-1838


Email:     tbf2inc@gmail.com

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