ICC Coach Training & Certification Registration (Stripe)

International Coach Training & Certification

Participant Registration Form
Title
Name*

First NameLast Name
Birthdate*

MonthDayYear
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone #*
Mobile #
E-mail*
example@example.com
Secondary E-mail
example@example.com
Degree
Previous Coaching Training*

I am an ICC certified coachI am coaching certified with another schoolI am not a certified coach
Occupation*
Company
Title
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Class - Group Information
City*
Class Begins*
Payment Method
Payment Options

Payment in FullPayment Plan

Program*

International Coaching Certification Program - Payment in Full

$5,950.00

International Coaching Certification Program - Payment PlanRegistration and 5 monthly payments of $800

$2,200.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

I understand and agree that I will be billed according to my payment option for the remaining balance of the program to the credit card or other payment method listed above. Signature*
Payment:

Paying by Credit Card: We accept Visa, Mastercard and American Express. If you are paying by credit card you can do so directly from the invoice you recieve.

Paying by check (U.S. ONLY): Contact us for instructions and address.

Paying by wire transfer: Contact us for instructions and account information.

GUARANTEED SATISFACTION POLICY: If after the training you did not learn any useful coaching techniques, we will give you a full refund.
Cancelation Policy: 60 days before starting - 100% refund minus $250 processing fee, 45-59 days before starting 50% refund, 30-44 days before starting 25% refund, less than 30 days before starting no refunds. This cancelation policy is in effect for all payment methods and plans.
If you have selected a payment plan, the first installment must be received prior to the first day of class.
If you are unable to complete the program you registered for in its entirety, you will have up to 24 months to utilize the credit towards a future cohort of the same program.
I have read and agree to the terms of Impact Coaching Solutions' Cancelation Policy. *
Signature*
Invoice Information
If the invoice needs to made out to your company please complete the information below to ensure proper billing.
Contact:

First NameLast Name
E-mail:
example@example.com
Company:
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please help us with our marketing efforts. This will help us reach others and keep our dream of "helping create a better world, one coach at a time."
How did you hear about us? *
If you were referred by a friend, please let us know who we can thank.
The person at Impact Coaching Solutions that helped me was:
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International Coach Training & Certification

Class - Group Information

Payment Method

Invoice Information