Welcome to TJA - Protect-Systems-International

Fax No: 239-458-8272

1301 SW 4th Court Cape Coral, FL 33991-2858 USA

Toll Free: 1-800-785-0100 | 239-458-8235

Healthcare and Educator Courses
" A DIVISION OF TJA USE OF FORCE TRAINING, INC."

Train the Trainer Pre-Registration


Dates: Please Select the seminar location you will be attending:

Name:
Titles After Your Name: Example: LPN, RN, LCSW
Home Address:
City:
State:
Zip Code:

Home Phone:
Cell Phone:
Primary Email Address:
Emergency Contact Name:
Emergency Contact Phone Number:

Company Name:
Your Position:
Work Address:
City:
State:
Zip Code:
Work Email Address:

Arrival Date:
Check Out Date:
Dietary Restrictions:
Your Flight Information: Please email us your flight information if you have it.
Please write (your name) exactly how you wish your certification to read, include professional initials that should appear after your name.
The instructor’s name will be listed on the CNVSPS® registry on the tjaPSI web site under the states you request to listed in. With the tjaPSI® Web Site: Which states do you wish to be listed under?

I have read and understand the cancellation policy, refund policy and TJA liability clause with regards to cancellation. I understand that instructor registrations form and other contracts will be mailed to me prior to the start of the class and must be filled out and the instructor registration must be mailed back and other forms brought with you to the class.

Following submisstion please submit a check to:

TJA Protect-Systems-International (Checks payable to TJA PSI)
1301 SW 4th Court, Cape Coral, FL 33991-2858

or submit payment by credit card

PLEASE NOTE

ONCE THIS FORM IS RECEIVED A DETAILED INSTRUCTOR REGISTRATION FORM, LICENSE & CONTRACT, CODE OF ETHICS AGREEMENT FORMS WILL BE MAILED DIRECTLY TO YOU.

Any questions, feel free to contact us at any time @ 1-888-785-0100 or E-mail: tom@tjaPSI.com

Train the Trainer Info

The Train the Trainer instructor registration form and other forms will be directly mailed to you once this PRE-REGISTRATION FORM is received at our office.

PLEASE MAKE A COPY OF YOUR PRE-REGISTRATION FORM FOR YOUR RECORDS!

The Train the Trainer program is recommended for In-Service Directors, Corporate Trainers, Instructors and Consultants who would be responsible for training healthcare professionals in non-violent self-protection or crisis management programs .For those professionals attending the Train the Trainer program, you will receive a certificate of completion. Upon completion of the Train the Trainer Program, you will receive an Instructor I.D. Number, which must go on all certificates that you distribute to your students. The Train the Trainer applicant must complete both Instructor Application and the Certification CNVSPS ® Application that will mailed. Please note: approved instructors may only teach the course after successful completion of the Train the Trainer program.

2011 Train the Trainer – Non-Violent Self-Protection Specialist CNVSPS

Please check back on the website calendar as more dates and locations will be added.

Time: 8:30 A.M. to 4:30 P.M.

Location:
If conducted at a facility or Hotel location it will be mailed with your confirmation notice. We recommend that you check in the night before the training.

Cost: $1295.00
Last registration for course two weeks prior to start of class date.

Hotel Reservations: MUST BE MADE BY YOU! Course fee does not include any travel and lodging.

Check in and Registration is at 8:00 A.M.
Train the Trainer Seminar begins promptly at 8:30 A.M.

Price includes: Curriculum Manual; Power Point Presentation on a USB Flash-drive; Emergency Response Belt® with carrier case, TJA Use of Force Healthcare Policy; three (3) year certification.

Hotel room, amenities such as movies & room service, transfers, and travel expenses are not included. The student is responsible to make their own travel arrangements.

Mid-morning & afternoon coffee/soft drinks and snacks included.

ALL COURSE MATERIALS ARE THE PROPERTY OF TJA AND ARE COPY RIGHTED BY TJA. YOU MAY NOT COPY ANY OF THE MATERIALS EXCEPT FOR TRAINING PURPOSES. ALL POWERPOINTS MAY BE USED FOR TRAINING PURPOSES ONLY. HAND OUTS MAY BE COPIED.

Payment Policy:
Payment must be received in full prior to the start of the class

Last Day to Register: Two Weeks prior to start of class.

Checks made payable to: TJA PSI
Mailing Address: 1301 SW 4th Court, Cape Coral, FL 33991-2858

Returned Check Fee: $45.00

Credit Cards Accepted: Call 1-888-785-0100 for payment details

You will receive written confirmation via e-mail and U.S. mail

Cancellation Policy: There are no refunds once the class begins. You must cancel in writing and cancellation must be received 30 days prior to the event. You must cancel by certified mail-return receipt only. There is a $100.00 cancellation fee. Please allow 4 weeks to refund money.

We reserve the right to cancel the course due to unforeseen emergencies and/or insufficient registration. TJA will not be responsible or held liable for any fees or penalties, incurred by you in regards to hotel or travel changes and charges. The class will be cancelled if we do not meet minimum enrollment. Notification will be mailed 30 days prior to the start of the class, if the course is to be cancelled. Cancellations will also be posted on the www.tjaPSI.com web site 30 days prior to the start of the class. We will make every effort to contact you by phone.

To apply as a TJA approved instructor, the applicant must meet the following criteria:

Train the trainer instructor registration form
Certified or licensed in a health care profession or social services
LPN, RN, EMT, PT, Paramedic, college degree, or graduate degree from an accredited college or university*
A minimum of 5 years experience in a health related field/profession.*
Minimum 3 years experience as a health educator and/or an instructor in health care* *In certain cases these may be waived – please call w/specific concerns.

Dress Attire: Business Casual

The student completing the course will be issued the “Train the Trainer” Course certificate and Instructor I.D. number, regardless of who is paying for the course. The certification number will be issued to the student. The certificate and certification will be valid for three years, from the date of the Train the Trainer Program. You must renew every three years for your certification to remain valid.

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