Registration Form

sexplorewithdentemin_explore

Intensive SAR Summer 2017 Workshop

Registration Form 

 

Name to appear on certificate: *
Name that we can use to address you (if different than above): *
Gender *
Pronoun: *
Occupation: *
Where did you hear about us? *
Address (Please indicate if this is your home or business address): *
Mobile/Phone Number (Please indicate if this is your personal or business phone number): *
-
E-mail: *
Short summary of related education, personal, and/or professional experience *
In a few words let us know why you are interested in participating in a SAR workshop *
Do you have any allergies, dietary, or medical concerns we should be aware of? *
We strive to make our workshops accessible. Please let us know what that means to you. We will try our best to create that for you. *
Select your course fee *
Payment must accompany your registration package in order for us to process your application. If there is still space available in the workshop you have chosen we will send you an email with instructions for payment to finalize your registration. *
Cancellation Policy: Please be advised that our cancellation policy is set in place because of the need to confirm meals and seating with the venue and catering company where the workshop will take place, and follows the cancellation policy that is sent to us by the venue. In the case of the Intensive SAR workshop the following payment schedule shall apply in case of a cancellation: 80-31 Business days prior to Friday, August 18th, 2017 75% of fees will be refunded. 30 Business days or less prior to Friday, August 18th, 2017 50% of fees will be refunded. As of Saturday, August 19th, 2017, no refunds will be given. Alternatively, you may send a substitute participant. No refunds or substitutions will be given to participants who do not attend without prior cancellation. Refunds will not be given to individuals who are not admitted due to lateness or who choose not to stay for any portion of training. Please be advised that applicable taxes and handling fees will be added to the above cancellation fees. The individual shall confirm in writing the cancelation or substitution of their participation by sending an email to dtemin@sexplorewithdentemin.com If, for any reason, the SAR workshop needs to be cancelled, we will make every effort to contact individuals as far in advance as possible in order to inform them. The workshop will be rescheduled, and the fees will be applied to the new date. We reserve the right to cancel the workshop due to low registration. *
By checking this box you are electronically signing this application form. *
Word Verification: