Course Registration Form

Thank you for your interest in our courses. Please call our office with any questions you have. 305-663-7195.

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Please complete this form to reserve your space in our courses. You will be sent an invoice that you can pay online with your credit or debit card.

1) Complete the personal and contact information section.
2) Select your Affiliations. The appropriate courses will appear for you.
4) Complete your reservation by clicking Continue.

Within 48 business hours, we will send you an invoice that you can pay online.

If you have any questions, please call our office and ask for Visnia. 305-663-7195, during the hours of Monday - Friday, 10am-4pm.

"*" indicates required fields

Name*
First Last Suffix
Name you like to be called*
This is the name that you prefer to be known as.

Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth*
Date of birth is required to distinguish your transcript records in our registration system.
MM slash DD slash YYYY

Email*
Enter Email Confirm Email

Phone*
Please let us know the best number in case we need to call you before the course.
Gender Pronouns*
What is your gender pronoun? Please select all that apply.
Affiliations*
You must select your Affiliation.

Please tell us if you are a Licensed or Certified Professional seeking CE units, or a current member of the Kiaora Society or Professionals Society member..

We can award CE units to the following list of professionals. Please review it now, as you will need to select your affiliation to receive the CE units. Florida Board Certified Professionals (Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling and Florida Board of Nursing - #50-1652. ), and the Florida Certification Board (Licensed Addiction, Child Welfare, Mental & Behavioral Health, Peer Specialist Professionals- #5292-A ) professionals.

There is an add on charge of $50/course fee for the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling and the Florida Board of Nursing - #50-1652 to submit the CE units to the Florida Dept. of Health-CE Broker.

Please tell us if you are a current Donor.

Please select None of the above, if none of the above applies to you.
License Number(s)*
You may enter dual licenses. CE units will be processed within 30 days of completing the course.

Course(s) Selection*
Choose the course(s) that you would like to participate in. As a Kiaora Society member you may take all of our courses at no charge. As a Professional Society member you can choose one course per year at no charge.
-- Select your course(s) --
Nov 19 2024 Intro to Neurodiversity Awareness & Best Practices - Waived Fee $30
Jan 25 & 26 2025-Communication Solutions™ - Waived Fee- $100
Course Name*
Please select your course. As a licensed professional with one of the above listed licenses, we will submit CE units to the appropriate governing board. The CE units Add-on option $50 is added to the base fee.

>> Communication Solutions™ and Communication Toolbox courses are the only courses available to receive CE Units. To register for any other course, please select the AFFILIATION - NONE OF THESE.
Course Name*
Please select your course. >> Communication Solutions™ and Communication Toolbox courses are the only courses available to receive CE Units. To register for any other course, please select the AFFILIATION - NONE OF THESE.
Course Name*
Please select your course. If you are a student, all the way up to doctoral students, select STUDENT.
No Charge for a Kiaora Society or Professional Member*
How did you hear about YES Institute?
What languages do you speak?
What do you hope to discover in the course?
AFTER you have clicked CONTINUE you will have reserved a space in the course(s) you have selected here.

Within 48 business hours we will send you an invoice that you can pay online. Once you have paid that invoice, you will be confirmed and registered in your course.

If you have any questions, or want to complete the payment over the phone, please call the office - Monday through Friday, from 9am - 5pm.

Thank you.
Total

Phone
This field is for validation purposes and should be left unchanged.

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