Online Registration for July 14 - 18, 2008
Neufeld Intensive Level Two in Vancouver

To register for the Neufeld Intensive Level Two in Vancouver, fill out the following form and then click "Submit" only once. When you have been redirected to the "Thank you" page, you'll know your registration has been received. If you have any questions or problems, please contact Dr. Neufeld's office.

Payment Options: There are two payment options, credit card or cheque. If paying by credit card, the full amount is due upon registration. Please follow the directions after submitting your registration form. If paying by cheque, a deposit of $100 is required to hold a space and the remainder is payable by June 15th. You may postdate the second cheque for the remainder if you wish. Make cheques payable to Growth Concerns and mail to:

    Dr. Neufeld's Office
    2155 West 36th Avenue
    Vancouver, B.C.
    V6M 1L3

Identifying & Contact Information:
First Name*
 Last Name*

Address
 City

Province/State
 Postal/Zip Code
Business Phone

Evening Phone
 Email Address*

Organization/School (if applicable)
 Position/Role in the organization or school

Sponsoring Agency (if applicable)

Prerequisite Intensive (Level One) with Dr. Neufeld

a) Please indicate what course you participated in (e.g., Vancouver 2003, 2004, 2005, 2006, 2007; Montreal 2005, 2006, 2007; Vancouver Island 2005 or 2006; Prince Rupert 2006 or 2007; Yukon 2006;Courtenay 2004-2005; Coquitlam Summer Institutes 2004, Surrey Counsellors Course 2005, Langley 2001)

Please enter the year and location of the Intensive you participated in.
or b) Registered in a homestudy or upcoming NEUFELD INTENSIVE Level One

Please indicate which.
Other exposure to Dr. Neufeld's material:
Impact of Neufeld's approach:


Reasons for wanting to take the Level Two Intensive.

Educational and professional background:

Role and experience with children:


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