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. It will direct you to our secure PayPal site though you can opt to put in a credit card and do not need a PayPal account. Please contact us if you have any difficulties.
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.

Registration Form

* Indicates required field

Name and Credentials of each Participant attending the conference. Please indicate how you will be attending the conference (Webinar or In Person). Participants may register together and attend in different ways. (Please # and list each person on a different line.) *

Email address of each Participant. This is important for communication about the conference/webinar. We do not sell email lists. (Please # and list each person as above.) *

Phone number of each Participant. Please be sure it is one that we may reach you at in case we need to reach you, especially if attending via webinar and we need to assist you. (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

Please select how you will attend the conference and then check both boxes for Terms and Agreements *

I/We will participate in the LIVE WEBINAR on Wed. Oct. 28, 2020 I/We will attend on Wednesday, Oct. 28, 2020 in Portland, ME I/We agree to the Cancellation and Substitution Policy: I may elect at any time up until 24 hours prior to the conference to attend either in person or via Live Webinar. I may also substitute someone to attend in my place. If I substitute someone for the webinar it must be done but 6:00 PM Eastern Time the day prior. If someone will attend in person, the substitution may be made up until the start of the conference. Cancellations received on or before September 15, 2020 will be refunded tuition minus a $30.00 processing fee. Cancellations received on September 16, 2020 up until 24 hours prior to the start of the day of the event registered for 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 with less than 24 hours prior to the start of the conference, no refunds or credits will be made and only a substitution will be allowed for an in person attendee. A participant may swap which way they would like to attend. However, to attend the Live Webinar, this change must be made before 6 PM Eastern Time as noted already to allow for set-up of the webinar procedures. In the event the Live Conference must be cancelled due to health and/or social mandates by the facility, town, state, county, or country, illness and/or other unexpected conditions of the speaker, or fire, strikes, war, acts of God, terrorism or other causes that would prevent the event from taking place, the provider (Coastal Education Services) will attempt to provide this event as a Live Webinar on the same day, as a live conference or webinar on a different day and/or location, or other arrangements most suitable to the majority of the participants. If the event is unable to be rescheduled/restructured the provider will refund all tuition fees paid. Costs incurred for non-refundable travel arrangements or other related individual expenses will not be paid by the provider. Returned checks will be charged a $40.00 fee. I/We agree to the Payment Policy: Purchase Orders will be accepted as a form of payment for the conference and may be received up until the date of the conference. Please have the person handling the Purchase Order contact Coastal Education Services at [email protected] or call 207-286-5631 and complete the form to the bottom right side. All other participants must pay tuition 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.

Please make payment below to the left using the drop down menu
or complete the form to the right for a check/purchase order.
We will add this to your registration form submitted above and confirm.

Click to set custom HTML

Complete below if Paying with
Check or Purchase Order
Purchase Orders must be RECEIVED prior to the start of the conference. (They 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 Person/People Registered for the Conference? *

Email address of person to be contacted for check or purchase order? *

Person's Name to be contacted for Check or Purchase Order? *

First

Last

Submit

Registration Form ​​​

​Please make payment below to the left using the drop down menuor complete the form to the right for a check/purchase order.We will add this to your registration form submitted above and confirm.

Complete below if ​Paying with ​Check or Purchase OrderPurchase Orders must be RECEIVED prior to the start of the conference. (They may be emailed to [email protected])

Registration Form

Please make payment below to the left using the drop down menu
or complete the form to the right for a check/purchase order.
We will add this to your registration form submitted above and confirm.

Complete below if Paying with
Check or Purchase Order
Purchase Orders must be RECEIVED prior to the start of the conference. (They may be emailed to [email protected])