Please note: Use the tab key or mouse to move between fields in the registration form. If you use the enter key, your registration will be submitted. Also, please enter your phone number and e-mail address so we can contact you more easily.
Name:
Address:
City:
State / Province:
Postal Code / Zip Code:
Country:
Telephone:
Email:
Gender:
 Female     Male
Emergency Contact:
Emergency Contact phone:
How many hours of training with certified NVC-trainers have you received?


For our reference,
how did you learn about this training?
Which IIT(s), if any,
have you completed?
Other past trainings with certified trainers
(Please list duration
and names of trainers):
   
Tuition
 7-day training: $850 US.  Early bird cutoff date is April 1, 2007
Sleeping room preference:

Note: Requests for single rooms will be honored in the order in which deposits are received.

Single Occupancy (room and board) $510 (7 days) Single
Double Occupancy (room and board) $495 (7days) Double 

Please note: Some accommodations have shared bathrooms.
Requested Roommate:
 
   Ground floor needed
 
  
Meals
  
Please list any dietary restrictions:

gluten-free
vegetarian
vegan
dairy free
   
Other
  
Any questions?
 For logistical questions:
Please contact Peggy Smith: 207-789-5299

For questions about the training or prerequisites,
Contact Robert Gonzales 928-771-2420
Completing Your Registration
  

Payment Information

A minimum of $250 deposit will reserve your place; with the balance being due on April 1st. You will receive a confirmation e-mail when we receive your deposit.

Make your check or money order payable to: “Robert Gonzales”

Mail ALL checks or money orders to:
Robert Gonzales
337 N. Rush St.
Prescott, AZ 86301

Registration is only finalized when the full tuition has been received.
How did you find us?
Other:
I agree with the terms and conditions of this training event as listed below. Type your name and today's date.
Print this form? We suggest printing a copy of this form for your records before submitting.
Please read notes below before clicking submit button.

NOTES: Paste the Fields required over the current fields in the above table.

See the 5 hidden fields at the top?

1. The first one is the recipient address currently "you@yourdomain.co.uk". Change this to be the address of the person to whom wants to recieved the emails.

2. The second is the Subject currently "Online Form Response". This can be changed to anything and acts as the Subject line that appears in the email recieved.

3. The third is the routine for what is displayed when the form is successful filled in and sent. "http://www.yourdomain.co.uk/thanks.html". Change this to display the thankyou page specific to the website. Saying something typically like "Thankyou for your Enquiry" or "Email Received with Thanks".

4. The fourth is the error page that is displayed... similar to that in part 3 exept it is displayed when the user hasnt filled in all the required fields define by the next note (5).

5. This is the required field part. In here Currently where it says Value = "Name" Change that to be the names of the required fields. seperated like this (if ALL of the fields in the above sample are required: "Name,Title,Company,Telephone,Email,Comments"

The last part is the FORM METHOD: <form method="post" action="http://www.yourdomain.co.uk/cgibin/FormMail.cgi">

This will need to be changed to point to the CGI script in your site.