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Workshop City , State and Date

Webinar Name and Date

Payment Information for Pending Order / Review Kit

Your Name

Name (this will appear on your certificate,( if issued) be sure spelling is correct)

Name of school you are affiliated with:

(Address, City, State, Zip and Phone)

Payment Information

MASTERCARD / VISA / DISCOVER /AMEX

Credit card number: Expiration Date: 3-Digit Code on back (4 digit code on front of AMEX cards)

Name on Card and Billing address, city, state and zip required (must match the credit card )

Purchase Order Number: Authorized by:

Purchaser's Email if you need a confirmation

Tell us how to get in touch with you:

PLEASE PROVIDE THE EMAIL FOR THE PARTICIPANT

Participant
E-mail
Tel
Fax

 

Required Fields

How did you hear about Gesell?

Choose one Catalog Referred by a friend Web search Referred by school administrator Conference Presentation Other

Please contact me as soon as possible regarding this matter.

We provide multiple sources of information for parents, teachers, and schools to assist in making important decisions about children.  We do not set policy or provide recommendations surrounding issues of retention, placement , or readiness "scores" in association with the Gesell Developmental Observation.

Cancellations: Gesell Institute reserves the right to cancel workshops and seminars due to low registrations or other unforeseen circumstances within two weeks of the start date. In the event of a cancellation, registrants will be notified and every effort will be made to find an alternative location or date that suits the needs of the registrant. When this is not possible, registrants will receive a full refund. Participant substitutions may be made; however, if a registrant cancellation or substitution is not received in writing within 5 business days of the workshop, a 10% fee will be charged.

Accommodations and Travel: Participants are responsible for arranging their own transportation, meals, lodging.  Gesell Institute will not refund any  booked lodging or travel reservations should a workshop be cancelled.

Payment: All workshop fees must be paid prior to workshop attendance.

By submitting this registration form, you have agreed to our terms set forth here.