Training of Trainers Registration, June 2022

TOT, June 2022

Contact information

Prefix

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

Preferred roomate

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, standard double occupancy room(Required)

Pay Now ($500.00)

Pay Later ($500.00)

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

Total

Enter your payment information below.

Your card will be processed securely and immediately.

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Credit Card(Required)

Card Details

Cardholder Name