LivingWorks Education - Public site navigation
[HOME]
about LivingWorksprograms and schedulesnewsresourcesstorecareerscontactsearch		other LivingWorks sites
français privacy

ASIST Training for Trainers (T4T) Registration Denver CO

Essential Information for Candidate TrainersFill out the form below and click the "Register Now" button once. An asterisk (*) indicates required information. You can also print and fax this form to +1 (403) 209-0259. Please note that LivingWorks reserves the right to cancel or postpone a course at any time if minimum seat requirements are not met. In the event that a course is cancelled, you will be refunded your full deposit and/or payment.

Course Dates: 15–19 September 2008
Location: The Hampton Inn And Suites
4150 East Kentucky Avenue, Glendale CO 80246
Ph: 303 692 1800
Block of rooms under LivingWorks (Cindy Hodge - organizer)
Shuttle service from Airport/Hotel/Airpot: SuperShuttle ph: 303-370-1300
All candidates are responsible for their own travel and accommodations.
Course Fee: $2550 USD
Add $50 if the slides for the trainer kit are required in overhead transparency format.
Course fee includes refreshments, lunches and ASIST Trainer Kit (Trainer Manual, Organizer's Guide, Implementation Guide, workshop audiovisuals, posters, slides, dissemination materials and carrier bag). Also included is suicideTALK, a complete program for providing awareness presentations.

Terms and Principles

  1. I have read the Essential Information for Candidate Trainers and understand the commitments that will be asked of me as a trainer.
  2. I have had time to consider my decision, to discuss it with my employer, and I have freely chosen to participate.
  3. I understand that the training materials I will receive can only be used by those who have successfully completed the five-day T4T course. My employer is aware that the training materials I will receive become my property, regardless of who pays my course fees.
  4. I must punctually attend all five days of the Training for Trainers course or risk having to retake the course.
  5. I need to work onsite either Wednesday or Thursday evening of the course.
  6. I should avoid any other commitments during the week as almost every waking hour is required for the course.
  7. I read well. I am a hard worker. I already have or I am willing to work hard to develop: strong presentation and small group facilitation skills, and an understanding of the scientific literature on suicide.
  8. I recognize that completing three workshops within the first year will establish my Registered status and presenting one workshop per year thereafter will maintain my Registered status. I also know that I will need considerable preparation time for my first few workshops.
  9. I recognize that material pricing for ASIST is subject to change. The current cost per participant kit is $35.00 CAD ($32.55 USD). Refer to website (www.livingworks.net) for latest pricing.
  10. I understand that this course prepares me for edition X of ASIST. Edition 6 and edition X trainers cannot work together to do an ASIST workshop.
  11. I understand that workshops should be conducted in a safe workplace setting.
  12. I appreciate that in the interest of maintaining standards, LivingWorks has the right to observe workshops that trainers present.
  13. I recognize that each individual trainer has the right to decide such implementation issues as marketing, prices and trainer fees although agreements among trainers in a region is recommended.
  14. I understand that I will need to arrange for the payment of the services of a Consulting Trainer should I be required to use them after T4T as part of the process of becoming a trainer.
  15. I understand that LivingWorks reserves the right to make final decisions regarding my potential to become a trainer. Only some portion of the materials costs is returned in those rare circumstances where a candidate is not authorized to continue in the process of becoming a trainer.

* I agree to the above Terms and Principles

Contact Information

LivingWorks will use the information you provide here to confirm and process your T4T registration and to provide you with ongoing trainer support after course completion. Your information and photograph (photo will be taken at your course) is kept strictly confidential and in our own database for the purpose of confirming your identity, recording training history and credits, collecting dissemination statistics, providing service and support, sending internal trainer communications and mailing completion certificates. You can update your information at any time by contacting LivingWorks’ main office. LivingWorks' Privacy Promise is found at www.livingworks.net.

*Your Name in Full (as it should appear on Certificates of Completion): M     F 
In what other languages could you serve as a trainer?
If you have worked with special populations, please specify knowledge/experience:

HOME

Home Address: City:
Prov/State:
Postal/Zip Code:
Country: *Home Phone (with area code):
Home Fax: *Home E-mail:

WORK

Organization:    
Department: Your Title:
Work Address: City:
Prov/State: Postal/Zip Code:
Country: Work Phone (with area code):
Work Fax:
Work E-mail:

*Which address should we use to contact you? HOME    WORK
The trainer network will be your lifeline. Your contact information will be available to this network for the purpose of organizing workshops and sharing resources unless otherwise indicated here: Please do not release my contact information to other trainers.

Payment and Options

*COURSE FEE: Canadian residents add 5% GST; North Carolina residents add 7% tax.
$500 USD deposit now due (non-refundable unless course is cancelled or postponed) with balance due by start of course. Term is net 30 days.

VISA     MASTERCARD    
-OR-
 Check #: -OR- N/A (covered by contract)
Card Number: Mail check(s) payable to:
LivingWorks Education Inc.
4303D 11 Street SE
Calgary, Alberta T2G 4X1		 This option only applies if your employer or organization has pre-arranged to pay your course fees. In this case, contact your organization for the registration code.
Organization:
Registration Code:
Cardholder's Name:
Expiry Date:
Amount:

*SPECIFY AUDIOVISUAL FORMAT (for the workshop videos in the Trainer's Kit): DVD   VHS     PAL DVD   PAL VHS

DIETARY AND ONSITE REQUIREMENTS
Refreshments and lunches are included. Please let us know of any special dietary requirements:
Please specify any special onsite needs concerning mobility, audio or visual accessibility:

 

 

(Click button ONCE. If you do not receive a confirmation message, contact LivingWorks)