Online Teaching Basics registration form

Online Teaching Basics | Self-Paced | Online

Please Note:
If you choose the PayPal option and you are not taken to the PayPal page after completing this form, it's likely that you have missed completing one of the required fields. Please check to see if there is an error message if you are not taken to PayPal.
About you:
General Data Protection Regulation (GDPR) Agreement*
- I consent to having this website store my submitted information so they can respond to my inquiry
Name*
First Last
Email address*
I identify my gender as:
Occupation:
A little more about you:
Address
City State / Province / Region Country
To help us work with you:
The questions below are designed to help us support you the most as you take this course with us. Please free free to contact Kristy Arbon (kristy@heartworks.training), if you have personal concerns that you would rather discuss in person. Your information will be kept confidential.
What do you hope to get out of this training?
Is there anything else you'd like us to know so that we can support you?
How did you hear about this course?*
Please choose all that apply.
- Social Media
- Word of Mouth
- HeartWorks website
- Email notification from Kristy
Course selection and registration:
Registration*
Please choose your level of registration below. Please contact Kristy (kristy@heartworks.training) if you need to discuss a different payment arrangement. I don't want finances to get in the way of you accessing this course. I will consider any offer to include you in this program.
- I can help out with scholarships ($50)
- I'm happy to be here at the middle rate ($40)
- I just need a little support to join the group ($30)
Payment Type*
- PayPal/Credit Card
If you are paying by check, please make the check out to:
Kristy Arbon
HeartWorks Training
PO Box 510441
St Louis, MO 63151
Total
$0.00
Comments
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