TBHI Pay By Check or Money Order
This form is for organizations or individuals wishing to pay for their TBHI training via check or money order. You may fill out this form online or print and mail completed form with the payment to the address provided below.
Order Details
Title of Training Course/Program
Enter full title of training you wish to purchase. For Example: 101 - Introduction to Telemental Health Theory & Practice
Your answer
Contact Name
Enter name of contact person for this order.
Your answer
Contact Email
Enter email of contact person for this order.
Your answer
Contact Phone
Enter daytime phone number of contact person for this order.
Your answer
Contact Address
Enter mailing address.
Your answer
Name as Seen on Payment (Check or Money Order)
Enter the name of the company or person as seen on the payment.
Your answer
Will Continuing Education (CE) Hours be Needed?
Please Note: Webinars are the same cost with or without CE Hours.
Number of Trainee(s)
Enter the number of trainees who will be taking this training. (Note: each trainee needs their own training account.)
Your answer
Trainee(s) Name & Email Address(es)
Please provide the names of all trainees and their preferred email addresses (if different from contact person).
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms