Order Form And Agreement
This agreement must be signed by the Instructor or Clinician who will be using audio/video materials and returned to THE TRAINING TAPES by fax, scanned documents, or delivered mail before any videotape is shipped.
The person(s) signing this Agreement guarentees that: To protect the confidentiality of families who appear on the videotape and in accordance with the conditions of the consent they have granted for the use of audio/video recordings:
a. This material will be shown only to mental health professionals or students in professional graduate or clinical training programs.
b. This material will not be duplicated.
Signature _____________________________________
Title _________________________________________
Institution _____________________________________
Mail payments of $ 95. plus shipping, payable to: Joel S Bergman, PhD. This Agreement can be printed out on any ordinary computer printer, scanned and emailed, or faxed directly to 212.777.0207, or sent along with payment to THE TRAINING TAPES.
Name of videotape or DVD(s) Specify DVD or Tape format. Specify with subtitles in Spanish or French.
____________________________________________
____________________________________________
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Name _______________________________________
Institution_____________________________________
Address______________________________________
City__________________________________________
State ____________________ Zip ________________
Phone ___________________ Fax________________
email ________________________________________
Contact Information
The Training Tape Series
303 Fifth Avenue, Suite 1905
New York, New York 10016
phone 212.777.6688
fax 212.777.0207