Letter of Engagement - Australia

Please complete the information below and click SUBMIT when finished.

We will add our signature and email a copy to you. 

Any questions, contact info@highconflictinstitute.com.

Name of Host Contact
Name of Host Contact
Phone Number
Phone Number
http://
ABOUT THE PROGRAM
Choose from following:
$
Event Date *
Event Date
Event Start Time
Event Start Time
Event End Time
Event End Time
Event Location *
Event Location
Day of Event Contact Cell Number
Day of Event Contact Cell Number
Do we have your permission to post general info about your event such as host group name, city, and program title on our website, newsletters, and social media.
MATERIALS
HCI will email host PDF materials to host by: *
HCI will email host PDF materials to host by: *
(Host will reproduce materials for event participants or provide them in accordance with organization preferences).
AUDIO VISUAL
Host Will Provide *
RECORDING
Training focus is: *
Attendees are Mostly:
(check all that apply)
CANCELLATION
Cancellation by Host: Cancellation fees are based on full amount of out-of-pocket (airfare, etc.) expenses incurred by HCI. Cancellation by HCI: A qualified substitute trainer will be provided unless Host prefers to change the date.
SIGNATURE
Date
Date
PAYMENT INFORMATION:
WIRE TRANSFERS: Wells Fargo Bank. N.A. 11275 E Via Linda, Scottsdale, AZ 85259 USA +1 480 614 8416 SWIFT code: WFBIUS6S Wire Routing Transit Number: 121000248 Account Number: 2988204034. High Conflict Institute, LLC, 7701 E. Indian School Rd., Ste. F, Scottsdale, Arizona, 85251, USA CREDIT CARD: If you are paying by credit card, we will add a 2.5% processing fee. We will send a link to the email address you provided above. You can pay securely with a credit card.
HCI Representative Signature (will be signed after receipt and emailed back to you)
THANK YOU! Your event is confirmed.