Virtual Prevention Leaders Cohort

Please note the following information about the course:

Which course will you be attending? *

Cohort Dates: Attendance at all dates is preferred.

Intensive I: October - December 2020
Intensive II: January - March, 2021
Intensive III: April - June, 2021
Intensive IV: July - September 2021

Exact dates and times will be included in your confirmation email.

Please fill out the information below for the person attending the course (participant).

First Name *

Last Name *

Email Address *

Organization *

Title

Address 1 *

Address 2

City *

State *

Zip Code *

Phone Number *

How did you find out about this course? *

What ToP Courses have you already completed?

Referral Name

Referral Email or Phone Number

Event Name

Please provide some details

We'd like to understand the role you play in your organization:

Role in organization *

I Facilitate *

I am interested in receiving credit for CEU's (select only if applies):

American Institute of Certified Planners (AICP)

American Planning Association (APA)

Certified Health Education Specialists (CHES)

Masters Certified Education Specialists (MCHES)

Board of School Administrators (BOSA)

Project Management Institute (PMI)

Coupon code

I would like to pay with a payment plan *

Yes

No

Do you need an invoice? *

Yes

No

Cancellation and Refund Policy: You will receive a full refund if you cancel prior to four weeks from the start date. You be refunded all but $100 of your registration fee if you cancel within four weeks of the course start date.

Upon arriving at the forms payment page, please choose "pay by check" to submit the form without providing payment at this time.

If you need any special accommodations, please list them here. If accommodations are needed, please let us know one month in advance so we can plan accordingly.

For questions or concerns please contact:

Stephanie Ahles
Phone: 612-387-0782
Email: stephanieahles@hue.life