Registration Page - Facilitating Self-Regulation

To Register for the Conference

1) Complete the Registration Form below.
2) If paying with credit card, use the "Buy Now" button below the registration form 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 are still being accepted up until the conference date.

Fill out the form below and press submit.

Select one of the locations/day you will attend then check both of the terms of agreement below. *

I will attend in Portland, ME on Wed. Nov. 13, 2019 I will attend in Manchester, NH on Thurs. Nov. 14, 2019 I agree to the Cancellation and Substitution Policy: Substitutions may be made at any time. All requests for cancellations must be received in writing to [email protected] no later than March 17, 2018 to receive a refund minus a $30. processing fee. No refunds will be issued for cancellations received on or after March 18, 2018. Instead, registrations may be substituted for another attendee, a different date for the same conference (day before or day after), or a credit for the amount paid may be given for use toward a future conference with Coastal Education Services. The latest a registrant may request a credit or make a substitution is 8:00 AM on the day of the conference. If a person does not make a written request or does not show up for the conference, no credit or substitution will be granted. 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. 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 or have a payment arrangement made prior to the conference date.

* Indicates required field

Name and Credentials of each Participant attending on Tuesday, March 27, 2018 in Manchester, NH (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

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 them 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 within 48 hours of your sending it.

Complete below if Paying with
Check/Purchase Order
for Facilitating Self-Regulation Conference

* 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

Names of Registrant(s) *

Contact Person's Email *

Contact Person's Name *

First

Last

Submit

Complete below if ​Paying with​Check/Purchase Order for Facilitating Self-Regulation Conference

Complete below if Paying with
Check/Purchase Order
for Facilitating Self-Regulation Conference