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ENROLMENT FORM
TRAINING LOCATION: 23 Parker Street Newmarket QLD 4051
DATES OF TRAINING:
TRAINING FACILITATOR: Chris Knight
10 DAYS: Nov 16th – Nov 27th 2015 (weekend off in-between)
Full Name:
DOB:
Name to appear on certificate:
Address:
Suburb:
State:
Postcode:
Telephone:
Mobile:
Email:
Emergency Contact:
Phone:
PSYCHOSOMATIC THERAPY TRAINING COURSE
Certificate of Psychosomatic Therapy Training is in accordance with the 10484NAT Certificate III in
Psychosomatic Therapy. Additional Logbook Hours to be completed to apply for national accreditation.
LEVEL 1
PYTOPA301A
Work within a Psychosomatic Therapy framework (1 day)
PYTOPA302A
PYTOPA303A
Plan the Psychosomatic Therapy analysis session – (Integrated
in all analysis subjects)
Perform Psychosomatic Therapy face analysis (1 day)
$375

PYTOPA304A
Perform Psychosomatic Therapy body-mind analysis (2 days)
$750

Body Mind Analysis – Feet, Limbs and Joints (1 day)
$375

Perform Psychosomatic Therapy hand analysis (1 day)
$375

Perform Psychosomatic Therapy anatomy analysis of potential
characteristics (1 day)
Apply Psychosomatic Therapy diagnostic framework (1 day)
$375

$375

Perform bodywork within a Psychosomatic Therapy framework
(1 day)
Apply reflective practice in Psychosomatic Therapy role (1 day)
$375

$375

PYTOPA305A
$375


LEVEL 2
PYTOPA306A
PYTOPA307A
PYTOPA308A
HLTCOM404C
Communicate effectively with clients/patients (Integrated)

HLTHIR506C
Implement and monitor compliance with legal and ethical
requirements
Total Fee for Course Units being undertaken

NOTE: Total training investment is $3750. Textbooks are not included in tuition fees and are available to
purchase on the first day of the course for $60 via eftpos, credit or cash.
Soul Space Brisbane
psychosomatictherapy.com.au
soulspacebrisbane.com.au
email: [email protected]
ABN: 21 621 463 952
Enquiries:
Soul Space: 07 3352 6155
Chris Knight: 0401 002 930
Jodie de Rome: 0403 534 637
$3750
Do you have any issues you might like to disclose so that we can offer you support,
ie. Sight impairment, English language and literacy, hearing loss, other
YES
NO
If yes, please specify:
PAYMENT OPTION
All payment options require $1000 deposit to secure your position in our training.
Tick your chosen payment option:
Full Payment $3750
Payment Plan $3895 ($145 admin fee incl.)
Total amount owing must be paid by 16/11/15
Total amount owing must be paid by 16/02/16
PAYMENT METHOD
O Electronic Fund Transfer (EFT)
Account Name: C M Knight, J T de Rome | Account no. 453033368
Ref:
O Credit Card
| BSB: 484-799 |
Bank: Suncorp
(place ref. number from bank transaction here)
Charges of
to be debited to my
O Visa
O Mastercard
Name of Cardholder (as it appears on card):
Credit Card Number:
Deposit being paid:
Expiry Date
$
OR
/
Full Amount being paid:
CSV
$
Invoice/receipts will be issued by email
PAYMENT SCHEDULE (if applicable)
If accepted by Soul Space Brisbane to pay course fees via the payment plan, $1000 deposit is required prior to commencement training
date. Full balance of payment MUST be completed within 3 months of start date. See below for payment schedule;
PAYMENT SCHEDULE - Total Charge $3750 + $145 (administration fee) = $3895
Date
11/12/15
Amount
$965
11/01/16
$965
11/02/16
$965
Signature
PARTICIPANT CANCELLATION & TRANSFER POLICY
Training fees are not refundable or transferable (including deposit). It is a condition of the Australian Psychosomatic
Therapy College that any missed day(s) must be repeated at a later date with the same teacher if you wish to receive
your certification.
TRAINING CANCELLATION POLICY
In the unlikely event extenuating circumstances occur such as sickness or bulk cancellations the course will be cancelled
and postponed to another date. We require a minimum of 5 participants to conduct the workshop and to cover
costs. We thank you for understanding.
I,
, agree to the registration conditions as outlined above for Psychosomatic Therapy training.
Date:
Soul Space Brisbane
psychosomatictherapy.com.au
soulspacebrisbane.com.au
email: [email protected]
ABN: 21 621 463 952
Enquiries:
Soul Space: 07 3352 6155
Chris Knight: 0401 002 930
Jodie de Rome: 0403 534 637