2026 Training Registration  
Name:__________________________________   Title:__________________________________________ Credentials:__________________ Professional License Number:______________________                                                                            Company Name:_________________________________________                                                          Company Address:_____________________________________ City:_________________________________________________                                                                          State / Province:__________________  Zip Code:________________________                                                      E-mail:_______________________________________________                                                                          Work Phone Number:___________________________Cell Phone Number:_____________________  Dietary needs for in person sessions:  
___ Gluten-free ___Vegan ___Vegetarian ___   Allergic:________________ 
Core DBT Training: 
____ Standard $1,500  ____ Early (30 days prior to training) $1,250  
____ Group of 4 of more from the same agency $999  
____ May 4-8, 2026
____ December 2026 (Dates TBD)
Introduction to DBT Training:   
____ Standard $375  ____ Early (30 days prior to training) $315  
____ September 2026 (Dates TBD)
DBT Skills Training: 
____ Standard $550  ____ Early (30 days prior to training) $475  
____ October 2026 (Dates TBD)
Adolescent and Family DBT Training: 
____ Standard $550  ____ Early (30 days prior to training) $475  
____ November 4-6, 2026
Total : $___________ No substitutions or refunds. Registration is not confirmed until payment has been received.  Mail check with registration forms(s) to: DBT Institute of Michigan, 2950 W. Howell Road, Mason, MI, 48854