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Use this form to register for Using Adult Development Theory to Coach Leaders, April 9-11, 2012 in Arlington, VA. Type your responses within each box. When finished, click the Print button to print this page and include it with your check.
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Your Name
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Street address
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City
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State Zip |
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Phone#
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Email: |
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Fee:
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Payment in full of $1,800 is due by March 9, 2012. Please make your check payable to Barbara Braham and mail it to:
Barbara Braham, 1143 Neil Avenue, Columbus, Ohio 43201
Upon receipt of your payment you will receive an email confirmation followed by the agenda for the event and the pre-work. Directions and hotel recommendations will be provided with your confirmation.
Cancellation Policy:
45 days before the event: Full refund
30 – 45 days before the event: Refund less $250 administrative fee
15 - 30 days before the event: 50% refund
Less than 15 days: No refunds
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Dietary
Information:
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Please specify if you would like vegetarian meals, or if you have food allergies we need to be aware of:
Vegetarian Food allergy: specify below: |
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MAP
Assessment:
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Please indicate the status of your MAP assessment:
I have completed the MAP. My stage of developemnt is:
____________________________________________
I have not completed a MAP assessment. I am enclosing the
additional MAP assessment fee of $325. Please send me the
materials to complete.
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Lodging
Information:
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Please check one of the following:
I need hotel information.
I would like to share a room, if possible.
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Adult
Development
Background
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Please describe any prior experience with developmental theory (reading, teleclass, workshop, etc)
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Your
Coaching Experience
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Please describe your coaching experience (training, years of coaching), and list any coaching credential (PCC, MCC, etc) you have earned.
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Print this registration form by clicking the button above. Then, mail this form along with your check to: Barbara Braham, 1143 Neil Avenue, Columbus, OH 43201
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