My Child Myself Facilitator – Registration

Use the form below to register for the online My Child Myself Facilitator Module 1 – Online Intensive – Sept. 20 – 26, 2021 – Mornings 9:30 – 11:30 am EDT

My Child Myself Facilitator Module 1 Registration

My Child Myself Facilitator, Module 1

1 Contact Information

2 About You

3 Payment Information

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Emergency Contact Name
First Last
Emergency Contact Phone*

Anthroposophical Programs/Trainings - Courses, Places & Dates*
Education - College, University, Trainings - Institution, Place, Dates, Degree/Certificate*
Personal interests, skills and work experience*

Fee
Scholarship Code
If you arranged to receive a scholarship, please enter your code here.
Your total is:
$ 0.00 CAD
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name