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

Registrants will meet on Feb 13, 20, 27, Mar 6, 13 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:

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)

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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?

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