Self Determination Training Registration : Programs : What We Do : Club 21 Learning and Resource Center

Please read and download course expectations here.

Apply for a scholarship here.

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First Name

Last Name

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

E-mail

Phone

Child Name

Child's Birthdate

Month

Day

Year

Child's Grade

What is Your Child's School Setting:

Club 21 Member?

This training is a perk of Club 21 Membership. Please confirm your membership.

Please select your payment option below.

Payment in full $200
$50 down payment + $50 next 3 month (be sure to select monthly payment in the credit card information section below)
I will be applying for a scholarship (which is a separate application)

Cardholder Name

Credit Card #

Expiration Date

Security Code

Make this a monthly payment?

Make this a monthly payment?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Self Determination Training Registration