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Global Flex Pricing Application Form

Please answer the following questions to be considered for our Global Flex Pricing program.

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Question 1 of 6

Name:

Question 2 of 6

Email: 

Question 3 of 6

For what training are you seeking Global Flex Pricing?

A

Level 1

B

Level 2

Question 4 of 6

When did you complete PACT Level 1 training? (if you have not completed Level 1, please enter N/A)

Question 5 of 6

In what country do you currently live?

Question 6 of 6

In what country or countries do you currently practice as a clinician?

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