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National Training Online, October 2023
Contact information
Prefix
Name
(Required)
First
Last
Pronouns
Email
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Phone
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Affiliation
Gamaliel Affiliate
(Required)
Yes
No
Gamaliel Affiliate or Partner Organization
(Required)
Name of your organization
(Required)
Accessibility instructions/requests
Photo/Video Release
(Required)
I agree to the following statement.
I hereby grant permission to Gamaliel and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Gamaliel and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview or presentation, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation A acknowledge that I am over 18 years of age.
Signature
(Required)
Payment options
Registration Fee
Price:
Cost If registered by COB, September 29, 2023 – $300 per person. If registered after September 29, 2023 – $350 per person. Your registration payment covers the cost of training, as well as any relevant resources.
Non Gamaliel Affiliate Registration Fee
Price:
Cost If registered by COB, September 29, 2023 – $600 per person. If registered after September 29, 2023 – $700 per person. Your registration payment covers the cost of training, as well as any relevant resources.
Total
Administration Code
The code above is for Gamaliel Staff use only.
Billing Address
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Street Address
Address Line 2
City
State / Province / Region
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Credit Card
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Card Details
Cardholder Name
