Training of Trainers, June 2023, Registration

Contact information

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Name(Required)

First Last

Pronouns

Email(Required)

Phone(Required)

Emergency contact

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Email(Required)

Rooming and accommodations

Accessibility instructions/requests

Travel Plans, Arriving date and time. Departing date and time. Car or Airport. Which airport and Flight # – arrival time.(Required)

Why do you need my travel plans? In some cases, we may be able to provide transportation but not guaranteed. Knowing your travel plans will help us coordinate transportation.

Payment options

Name of your affiliate organization(Required)

Payment(Required)

Pay Now ($600.00)

Pay Later ($600.00)

Payments are due at the beginning of training, payment options will be available on your confirmation email. Questions about payment contact Regina Mahone at 312-357-2639

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Your card will be processed securely and immediately.

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