Registration Page - Strategies for Reflex Integration & Visual Perception

  To Register for the Conference

1) Complete the Registration Form below for all participants wanting to attend. Then pay with a card below the registration form with the drop down menu or complete the form to the right side below to pay with check/PO.
2) If paying with credit card, use the "Buy Now" button below the registration forms on the bottom left side.
3) If paying with a check or purchase order, please complete the form on the bottom right side. Purchase Orders will be accepted up until the conference date with an arrangement made with the business creating the P.O.
4) In order to get the discounted rate of 2 or more participants, they must register at the same time on the same form.

Wednesday, April 8, 2020
Presented as a LIVE WEBINAR

Registration Form

* Indicates required field

Name and Credentials of each Participant attending the LIVE WEBINAR on Wednesday, April 8, 2020. (please # and list each person) *

Email address of each Participant: (please # and list each person as above) *

Phone number of each Participant: (please # and list each person as above) *

Billing Name/Organization (Line 1) and Street Address (Line 2) *

Line 1

Line 2

City

State

Zip Code

Country

Terms and Agreements (Please check both boxes) *

I agree to the Cancellation and Substitution Policy: Substitutions may be made at any time. Cancellations received before March 7, 2020 will be refunded tuition minus a $30.00 processing fee. Cancellations received between March 8 - April 7, 2020 will receive a credit voucher for the tuition value towards a future conference sponsored by Coastal Education Services. Credit vouchers do not expire. If cancellation is received on April 8, 2020, no refund will be given, though substitution may still be made. Request for substitutions must be made prior to the end of registration/start of the conference beginning. In the event the program must be cancelled due to illness, fire, strikes, war, acts of God, terrorism or other causes that would prevent the event from taking place, the provider will attempt to reschedule the event. If the event is unable to be rescheduled, the provider will refund all tuition fees paid. Costs incurred for non-refundable travel arrangements or other related individual expenses will not be refunded. Returned checks will be charged a $35.00 fee. I agree to the Payment Policy: Purchase Orders will be accepted as a form of payment for the conference. Please have the person handling the Purchase Order contact Coastal Education Services at [email protected] and complete the form below. All other participants need to pay in full by the date of the conference or have a payment arrangement made prior to the conference date.

Submit

Once you have submitted your registration form above, please select how many participants you will be paying for below. When you click the "BUY NOW" button below, you will be redirected to our secure sales merchant of PayPal and will not be able to connect back to our website. This is a security procedure. Please revisit our website and if you have any questions, you may submit your questions by completing a form under the "Contact" tab at the top of the pages or call us at 207-286-5631.

If you are paying with a Check/Purchase Order, please complete information below so we can match a form of payment with your registration.

We will confirm the receipt of your registration and/or payment typically within 48 hours of your sending it.

Complete below if Paying with
Check/Purchase Order
for the Strategies for Reflex Integration and Visual Perception Conference. Purchase Orders must be RECEIVED by April 7, 2020 (may be emailed to [email protected])

* Indicates required field

How do you plan to pay if not by credit card? Checks may be made payable to Coastal Education Services and Mailed to P.O. Box 3064, Kennebunkport, ME 04046. Purchase Orders may be emailed to [email protected] *

Personal Check Business Check Purchase Order

Name of Registrant(s) *

Contact Person's Email Address for Purchase Order *

Contact Person's Name for Purchase Order *

First

Last

Submit

Wednesday, April 8, 2020Presented as a LIVE WEBINARRegistration Form ​​​

Complete below if ​Paying with​Check/Purchase Order for the Strategies for Reflex Integration and Visual Perception Conference. Purchase Orders must be RECEIVED by April 7, 2020 (may be emailed to [email protected])

Wednesday, April 8, 2020
Presented as a LIVE WEBINAR

Registration Form

Complete below if Paying with
Check/Purchase Order
for the Strategies for Reflex Integration and Visual Perception Conference. Purchase Orders must be RECEIVED by April 7, 2020 (may be emailed to [email protected])