LEVEL II REGISTRATION

Name *

First Name

Last Name

Phone *

(###)

###

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Date of Birth *

All Level II Trainees must be at least 18 years old.

MM

DD

YYYY

Do you currently have an ACCT Level I Certification? *

We require all Level II Trainees have either a current Level I Certification or equivalent experience.

No

Yes

Other Equivalent Experience

Do you currently have at least 200 documented facilitation hours? *

After submitting this form, please email your portfolio to Kevin@teamsynergo.com

Yes

No

Which Level II Training date will you be attending?

October 17-21, 2022

Spring 2023