Contact Info
Name
First: Last:
First:
Last:
Mailing Address
Address: City: Province: AB BC MB NB NL NT NS NU ON PE QC SK YT Postal Code:
Address:
City:
Province: AB BC MB NB NL NT NS NU ON PE QC SK YT
Postal Code:
Telephone Numbers (eg. (XXX) XXX-XXXX)
Home: Office: Fax:
Home:
Office:
Fax:
E-mail:
Training Info
Enter what type of training you have completed (eg. Basic week)
Course:
Instructor:
Date:
Membership Type
Associate - $15.00/yr
Certified - $25.00/yr
Certified with business card - $35.00/yr
Certified with business card and link to personal website - $50.00/yr
Payment
Send a personal cheque or money order made payable to WGI - Canada and send it to...
Jean Seville Suffield, Treasurer WGI-Canada 247-365 rue de Châteauguay Longueuil, QC J4H 3X5
Jean Seville Suffield, Treasurer WGI-Canada
247-365 rue de Châteauguay
Longueuil, QC
J4H 3X5
Business Card Memberships
For Business Card memberships (click here to view a sample) please provide the following information...
Business name:
Specialities (eg. Counselling, Training, Seminars) :
Website URL:
William Glasser Institute - Canada William Glasser Institute - Canada