Registration
Training Check-in starts at 12:20pm
Training Starts Promptly at 12:45pm
Training Ends at 5:45pm
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Organization Contact
First Name:
*
Last Name:
*
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
*
Postal Code:
*
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Questions/Options:
1. Organization / Business Name:
2. Number of Attendees ($25 per Attendee):
3. First & Last Name(s) of each Attendee as it should appear on name tag(s):
4. Total Fee (Number of Attendee(s) x $25 =
Additional Information:
$20 Fee per Attendee
(Show-Hide Details)
I understand there is a $25 fee per attendee.
I've read the above and agree.
Payment and Cancellation
(Show-Hide Details)
Payment: The total amount due will be processed immediately. If you cancel prior to 10-1-2013 a refund will be processed to your credit card.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
02
03
04
05
06
07
08
09
10
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12
Exp Year:
*
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
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2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
*
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