IEP Registration : IEP Support : What We Do : Club 21 Learning and Resource Center

IEP Workshop Registration

Please note: this registration is only valid for the workshop specified above. If you would like to attend any additional workshops, you will have to register again.

This will be a Transition IEP support workshop for families about to do their transition from their Regional Center to the School District.

Please note: you must be a current Club 21 member to register for the workshop.

This workshop has a $10 fee.

Name (first and last)

E-mail

Phone

Child Name

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Age of Child

School

Are you a Club 21 Member?

If you are not a Club 21 member, please complete your membership after completing this registration.

Yes
No
Unsure

Credit Card Information

Cardholder Name

Credit Card #

Expiration Date

Security Code

Billing Zip Code

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged