2021 June/July- MST-CAN Trauma training MST UK

First name *

Family name *

Date of birth *

Education: (Dutch and Belgium participants please choose HBO or WO)

Year of graduation

Role in MST team *

therapist

supervisor

Name MST Expert

Name MST team

Name agency or organization

Notice: We follow the Data Protection Regulation (GDPR). Due to the Covid-19 virus, we can temporary send training materials to your home address. We will delete private addresses, after sending the materials.

Business phone number *

Business e-mail MST candidate for certificate and communication after CAN training *

Business e-mail MST candidate or supervisor for confirmation registration *

Shipping address *

Shipping address

Name organization or full name when using home address

Address

Zip

City

Country

Purchase number if needed

Billing address
Dutch and Belgium participants can leave this open

Billing address <br> Dutch and Belgium participants can leave this open

Zip/Postal

City

Country

For Dutch and Belgium participants only:
Vul hieronder je accreditatie registratie/lidnummers in (dit kunnen er meerdere zijn):

SKJ

VGCT

FGzPt

NVO

NIP

VPeP

NVP

Permission to use photos *

Yes, MST Netherlands and Belgium may use photos that I am on.

No, MST Netherlands and Belgium may not use photos that I am on.

During the MST (tele-)training, workshop and boosters, we occasional take photos to promote MST. For example for the website, newsletter, fact sheets, social media, etc. etc. Let us know if we can use the photos that you are on? When selecting the photos, we of course make sure, that everyone is looking their best.

Notice: We follow the Data Protection Regulation (GDPR). Due to the Covid-19 virus, we can temporary send training materials to your home address. We will delete private addresses, after sending the materials.

For Dutch and Belgium participants only: Vul hieronder je accreditatie registratie/lidnummers in (dit kunnen er meerdere zijn):

For Dutch and Belgium participants only:
Vul hieronder je accreditatie registratie/lidnummers in (dit kunnen er meerdere zijn):