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

Self Determination Training Registration

Below is the registration for the Winter 2022 session of the Self Determination workshop.

Registrants will meet on February 20, 27, March 6,13, and 20 from 3:30pm-5:30pm virtually. If you have any questions, please email programs@clubtwentyone.org.

Please read and download course expectations here.

Apply for a scholarship here.

First Name (Required)

Last Name (Required)

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

E-mail (Required)

Phone (Required)

Child Name (Required)

Child's Birthdate

Child's Grade (Required)

What is Your Child's School Setting:

Homeschooled
General Education
Special Education
Day program
Other

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Club 21 Member? (Required)

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

Please select your payment option below.

Payment in full $100
$50 down payment + $50 next 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)

Credit Card Information

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Make this a monthly payment?

Yes, bill my card today and on the 29th of every following month. (if the month doesn't have 29 days, your card will be billed on the last day of the month.)

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