Program Registration Form (Paid Adult & Family)

Close Form/Program Full

Yes

Program ID*

Select Service*

Staff Email

example@example.com

Zoom Link

Service Schedule Name*

Additional Attendees Question

Yes

Program Fee (per session - members)*

Program Fee (per session - nonmembers)*

Program Fee (full series - members)*

Program Fee (full series - nonmembers)*

Session 1*

Date

Session 2

Date

Session 3

Date

Session 4

Date

Session 5

Date

Enter title & program description here....

{ProgramTitleDescription}

Pricing Structure:

	Full Series	Individual Session
Member	${FeeSeriesMember}	${FeePerSessionMember}
Non-Member	${FeeSeries}	${FeePerSession}

Pricing:

Member	${FeePerSessionMember}
Non-Member	${FeePerSession}

Are you an active member?*

YesNo

Would you like to add a membership or renewal to your cart today?*

Family Membership ($60.00)Individual Membership ($40.00)Do Not Add Membership

Please Note: To receive the member rate on additional attendees, you must maintain a Family Membership. Attendees outside of your family need to be registered separately at the non-member rate.

Are you registering for a full series or individual sessions?*

Full SeriesIndividual Sessions

Session 1

Session 2

Session 3

Session 4

Session 5

Participant Name*

First NameLast Name

Will there be any additional attendees from your household?*

YesNo

How Many Household Attendees Total (including yourself)

* If you are a member registering people not covered under your family membership (your immediate family or household) you will need to register them seperately with non member pricing. Thank you.

Email*

example@example.com

Preferred Email

Primary Phone Number*

Please enter a valid phone number.

Preferred Phone

Mailing Address

Street Address

CityStateZip CodeCountry

I would like to make a donation to White Memorial!

Donation Amount

Amount Due

USDIncludes registration fee and membership fee (if applicable)

Credit Card

I would like to cover the credit card fees

Credit Card Fees

White Memorial’s Cancellation and Refund Policy for Public Education Programs:

Public education programs are defined as those in which customers register and purchase tickets as individuals. Public education programs are listed on White Memorial's Calendar of Events. Please notify White Memorial of all cancellations as soon as possible so that those "spots" can potentially be opened for other customers. Email info@whitememorialcc.org or call 860-567-0857 to report cancellations.

When a single education program costs under $10 per ticket, payments are non-refundable at any point. For programs (exclusive of Discovery and Exploration Camp) that cost over $10 per ticket, refunds will be issued upon request by the customer if the request is made at least 48 hours in advance of the program. Any refund requests made within 48 hours, or anytime after the program, will not be granted. A $20 administrative fee (per ticket) will be retained by White Memorial for any tickets costing $40 or more. Please email info@whitememorialcc.org or call 860-567-0857 to request a refund.

For Discovery Camp and Exploration Camp, refunds will be issued (minus a $20 administrative fee per child) if a cancellation is made at least two weeks prior to the first day of the camp your child is enrolled in. Refunds will not be issued for any cancellations made less than two weeks from that first day.

If White Memorial needs to cancel a program for any reason, refunds will automatically be issued to all customers. However, please email info@whitememorialcc.org or call 860-567-0857 if you would like your payment to be retained as a donation to White Memorial. We would be very appreciative!

Thank you.

Thank you for your interest in our program! Unfortunately, this event has sold out. Please check our calendar for more upcoming events!

For questions or concerns, please email kelly@whitememorialcc.org.

Membership Purchase Amount*

Final Program Purchase Amount*

Membership + Program + Donation Amount

Payment Fees Covered by Customer*

Final Payment Due

Donation Amount (converted to #)

Series Fee (member/non-member)

Session Fee (member/non-member)

Number of Sessions Chosen

Total Session Fees

Payment Fee Percentage*

Service Delivery Quantity

Purchased a Membership

TRUE

Received Member Pricing

TRUE

Session 1 Chosen

TRUE

Session 2 Chosen

TRUE

Session 3 Chosen

TRUE

Session 4 Chosen

TRUE

Session 5 Chosen

TRUE

Program Registration Form

Participant

Contact Information

Payment

Credit Card