ICISF Group Crisis Certification Registration Form
ICISF Group Crisis Certification (International Critical Incident Stress Foundation) Registration Form Space is limited. Register now! October 4-5, 2019, 9:00 am - 5:00 pm daily (must attend 9am-5pm both days to achieve certification) ICISF Certified Instructor Dwight Bain Training facility: Church on The Drive, 1914 Edgewater Drive, Orlando, FL 32804 PLEASE PRINT your name clearly as you would like it to appear on your National Certification Name: __________________________________________________________ Address : _____________________________________________________________________ Telephone : _____________________________________________________ E-mail : ________________________________________________________ ____ $199.00 - early bird registration (by September 6th ) ____$219.00 - late registration ( after September 6 th if space is still available ) _____$5.00 (optional) if Continuing Education credits are required (1