Materials Use Form

The information provided here serves several purposes:

It keeps BTECH apprised of the activities of affiliate organizations.
It keeps records related to use of BTECH materials.
It also helps us provide informed responses to inquiries we periodically receive about activities of affiliate training organizations.

We ask that you please maintain current records about your activities using this site.

Please note that all activities of Tier 2 Affiliates must be approved by the lead BTECH Trainer before being entered here.

Training Information

Organization(Required)

Your name(Required)

First Last

Your email address(Required)

Training beginning date

Training ending date

Event title(Required)

Event location

City State / Province / Region ZIP / Postal Code Country

Add additional information to send to BTECH:

Is there any additional information or explanation you would like to provide to BTECH about this event?

BTECH trainer names:

If this training involves BTECH trainers, please provider their names.

# of Participants:(Required)

Please enter a number from 1 to 64.

# of Participants:(Required)

Please enter a number from 1 to 75.

# of Participants:(Required)

Please enter a number from 1 to 125.

# of Participants:(Required)

Please enter a number from 1 to 125.

Non-English Trainings

Are you translating the materials into a language other than English?(Required)

Yes

Translator Name:(Required)

First Last

Translator Location:(Required)

Translator Phone:(Required)

Translator Email:(Required)

Language Into Which Material is Being Translated:(Required)

Purpose of Translation:(Required)

Estimated Date of Translation Completion:(Required)

Terms and Conditions

Consent(Required)

By clicking this box, you agree to the terms and conditions of the agreement below.(Required)

This agreement is made by and between Behavioral Tech Institute (“BTECH”) having a principal place of business at 700 Seneca Street,
Suite 107 #167, Seattle, WA 98101, and the undersigned (“Recipient”), whose name and address appears below.

The Recipient desires to utilize the BTECH owned materials and/or content noted in this agreement. In exchange for the use of these
materials and/or content, Recipient acknowledges and agrees to the following terms and conditions.

1. Release of All Claims against BTECH. Recipient hereby agrees to release BTECH from any and all claims and liabilities for personal injury or property damage which occurs as a result of the use of the material and/or content.

2. Recipient hereby agrees to protect the confidentiality of this agreement and agrees to not disclose the terms outlined here. Recipient further agrees that the materials and/or content will be used in accordance with the terms of this contract, including restrictions against copying or distribution of the materials for any other purpose. Recipient agrees to not modify the formatting of the materials and to keep all BTECH branding in place.

3. Recipient understands and agrees that the materials use fee must be received by BTECH prior to release of the materials. Failure to pay may result in delay or total revocation of materials agreement.

4. No Liability for Consequential Damages. IN NO EVENT SHALL BTECH BE LIABLE TO YOU FOR ANY CONSEQUENTIAL, SPECIAL, INCIDENTAL, OR INDIRECT DAMAGES OF ANY KIND ARISING OUT OF THE USE OF THE MATERIAL AND/OR CONTENT, INCLUDING LOST PROFITS, DAMAGE TO PROPERTY AND, TO THE EXTENT PERMITTED BY LAW, DAMAGE FOR PERSONAL INJURY, EVEN IF BTECH HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. BTECH’S LIABILITY FOR ANY CLAIM, LOSSES, DAMAGES OR
INJURY, WHETHER CAUSED BY BREACH OF CONTRACT, TORT, OR ANY OTHER THEORY OF LIABILITY, SHALL NOT EXCEED THE FEE
PAID BY YOU FOR THE USE OF THE MATERIALS AND/OR CONTENT, IF ANY.

5. Governing Law. This agreement shall be governed by and construed in accordance with the laws of the State of Washington.

6. Entire Agreement. This agreement constitutes the entire agreement between the parties and supersedes all prior or contemporaneous oral or written agreements with respect to the subject matter contained herein.

This Agreement may only be changed by mutual agreement of authorized representatives of the parties in writing.

Payment Form for Use of Materials

Total Due for Materials Use (all prices are in US Dollars)

Price: $0.00

Credit Card

Total

Name

This field is for validation purposes and should be left unchanged.