Triple P – Positive Parenting Program®
September 9-20, 2013
Registration Form
Raleigh, NC
SECTION 1: Personal Details
Title:
First Name:
Last Name:
Qualifications:
Organization:
Position:
Address:
City/Town:
State:
T: Work
Zip Code:
Mob/Cell:
Fax:
Accounts Payable
Contact Name and
phone number:
Email:
SECTION 2: Payment Details
Check/Money Order
(please choose an option)
Please find a check/money order for $.......................... enclosed
Please debit $.......................... from credit card
Visa
MasterCard
Discover
American Express
Card No.
Credit Card
Expiration
Date:
Name on Card:
3 or 4 Digit
Code:
Signature:
Please issue an invoice to: (please note a purchase order is required for all invoice requests)
Name:
Invoice $_________
Organization and
Address:
Purchase Order No:
Invoice Email Address:
Please send your completed registration form to:
Attn: Kristin Patterson, Training Coordinator, Triple P America
Mail: 1201 Lincoln Street, Columbia, SC 29201
Fax: 803-451-2277 or Email: [email protected]
SECTION 3: Triple P Provider Training Course
Please check  the box of the training you wish to attend
All courses include: training and accreditation fee, training materials, training resources, access to the Triple P Provider
Network, and catering (morning break, lunch, and afternoon break).
Training Courses and Resources
Training Dates
Accreditation
Dates
Price
Check
Box
September 9-11, 2013
TBD
$2,170.00

September 12-13, 2013
TBD
$1,500.00

September 16-18, 2013
TBD
$2,170.00

September 19-20, 2013
TBD
$1,625.00

Level 4 Standard Triple P
(3 days training + 1 day accreditation*)
Triple P Training Resources included:
Practitioner’s Kit for Standard Triple P; Every Parent’s
Survival Guide DVD
Standard Teen Extension Triple P (Level 4)
(2 days training + 1 day accreditation*)
In order to attend this course, registrant must be
signed up for Standard Triple P on September 9-11.
Triple P Training Resources
included :Practitioner’s Kit for Standard Teen Triple P;
Every Parent’s Guide to Teenagers DVD
Level 4 Group Triple P
(3 days training + 1 day accreditation*)
Triple P Training Resources
included :Practitioner’s Kit for Group Triple P; Every
Parent’s Survival Guide DVD
Level 5 Pathways Triple P
(2 days training + 1 day accreditation*)
In order to attend this course, registrant must be
trained in a Level 4 Triple P Program.
Triple P Training Resources included :
Practitioner’s Kit for Pathways Triple P; Coping with
Stress DVD
CANCELLATIONS:
Triple P reserves the right to cancel this training no later than two weeks prior to the training date if registration
numbers are too low to hold an effective training. If cancellation on behalf of Triple P occurs, all registration fees will
be returned to the registrant.
In case of a cancellation on behalf of the registrant, after August 25 2013, registration costs will be refunded less an
administrative fee of $250.00.
TRIPLE P PROVIDER TRAINING AND CONTINUING DEVELOPMENT POINTS:
Some training participants seek Continuing Education Units for attendance at Triple P Provider Training Courses from their
professional body. Many professional bodies require their members to attend regular professional development events such as
conferences and training courses as part of their ongoing registration requirements. Recognition of your attendance to Triple P
Provider Training can be supported by presentation of your Triple P Provider Accreditation letter and Triple P provider
Accreditation Certificate from the University of Queensland. Should you require further documentation, please contact Triple P
America at [email protected]
GENERAL INFORMATION:
Confirmation with further details regarding the venue and surrounding area of the venue will be forwarded to the participant upon
receipt of the registration form and payment. Please contact the Training Coordinator ([email protected]) if you do not receive
your official course registration confirmation and need to finalize travel arrangements.
ACCREDITATION:
ACCREDITATION DATES AND TIMES WILL BE ESTABLISHED DURING THE TRAINING EVENT AND PARTICIPANTS
WILL BE EXPECTED TO BE PRESENT, UNLESS THE PARTICIPANT LIVES OVER 120 MILES FROM THE VENUE. FOR
THOSE PARTICPANTS TRAVELING OVER 120 MILES, YOUR ACCREDITATION MAY BE COMPLETED, FREE OF
CHARGE, VIA DVD SUBMISSION. GUIDELINES FOR THIS WILL BE DISTRIBUTED AT THE TRAINING EVENT.
IF A PARTICIPANT MISSES THEIR SCHEDULED ACCREDITATION TIME FOR A NON-EMERGENT REASON THEY MAY
ALSO BECOME ACCREDITED VIA DVD SUBMISSION BUT WILL BE CHARGED $250 FOR THE FIRST 3 COMPETENCIES
AND $50 FOR EACH COMPETENCY THERE AFTER.
AGENCY TRAINING
Agency-based Triple P Provider training courses can also be provided to agencies in the US where there are up to 20 staff to be
trained. Please contact Triple P America for more information ([email protected]).