LIVING the Dementia Journey Facilitator Training Registration Form

Name

First Last

Position/role:

Organization:

Email address

Phone number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have any food allergies or dietary restrictions?

To be accepted to attend this training, please confirm that you:

Have prior teaching or facilitation experience in dementia care, care of the elderly or a similar health field.
Have teaching or facilitation as part of your job responsibilities.

Please upload one of the following so that we can review your qualifications:

Typed letter and resume or CV explaining your work experience
Typed letter and resume or CV explaining your work experience

If accepted, you will be required to sign an agreement outlining expectations and restrictions for delivering LIVING the Dementia Journey education and for tracking delivery.

Once certified, facilitators can provide the program within their designated organization, region or territory as part of their job responsibilities (facilitators cannot charge participants for their time).

Facilitator Training (train-the-trainer) workshop pricing*:

1) 3-consecutive 8-hour days ($900 per participant, including materials and lunch/snacks/refreshments). Certified Facilitators or the organizations they’re working with can then purchase workbooks for the Learner’s Overview and In-Depth Modules Workshops for $30 each* plus shipping.

*Tax does not need to be added on to these amounts since the RIA is a charitable, non-profit foundation.

LIVING the Dementia Journey Facilitator Training Registration Form

LIVING the Dementia Journey Participant Education Registration Form