Kink Conscious Certification Registration

First Name *
Email Address *
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Contact Number *
Are you an IICS student? *
Last Name *
Street Address *
State *
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Professional License Number

Please upload documents in PDF, doc or docx (Microsoft Word) format. Documents larger than 5MB should be uploaded in a ZIP format. If you have some other document type, please create a ZIP file for upload. Images for drivers license should be jpg, png or in a ZIP file.


Resume or CV
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Professional license or Certification
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Driver’s license
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Payment Information

I understand that I may pay the entire tuition of $2,900.00 in full or $1,450 for fist consecutive 5 days and then $290 per month for 5 months. I understand that I am liable for payment in full by the final class. I understand that if I make payment in full, there will be no refunds if I do not complete the program.

Please Contact Us if you have any questions.


right arrow  Click here to view Continuing Education provided by Dr. Carol L. Clark & Therapy Certification Training.

All Board approvals of CE Credit Hours are for CEs ONLY, not certifications. Only the Therapist Certification Association Board may certify graduates of our certification programs: 

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9620 NE 2nd Ave | Suite 205
Miami Shores | FL 33138
(305) 891-1827

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