| Name: |
| Mailing Address: |
| City: |
| Home Phone: |
| Cell Phone: |
| Work Phone: |
| Email: |
| Credit Card Type: |
| Tuition Options (please select one): |
| Comments and Discount Codes: |
| Once your registration form has been processed, you will receive a confirmation email in 2-3 business days that includes both a receipt and a seminar introduction packet. You will be charged a $100 cancellation fee if you withdraw from the program less than 2 weeks prior to the first seminar. No refunds can be given once the CDA seminar program has begun. Your submission of this form indicates your acceptance of these policies, and a commitment to pay your tuition in full. |
| Card Number: |
| CV Number: |
| City: |
| Billing Address: |
| Name on Card: |
| State: |
| Zip Code: |
| State: |
| Zip Code: |
| Please complete all information. When you click on the submit button, your credit card will be charged based on the tuition option you have selected. To receive the discount for prepaying for the entire course, be sure to click that option. If you are eligible for the director's discount be sure to put your director's name & phone number in the comments box below. You will not need to fill in the credit card information. Any NAEYC training discounts will be credited to the final payments. You will receive a confirmation email and seminar information packet within 2 - 3 business days. |
| Please Note: You MUST click on the TOP of each box in order to type in information. |
| Expiration Date: |
| Employer: |
| Address: |
| CDA Options (please select one): |
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