Pacific College Elevate, Charisma & Context Registration Form

El Segundo Charisma & Context Registration Form

Fill out the form carefully for registration
TWO WAYS TO REGISTER
1. With Your Organization’s Tuition Assistance & Our University Partner’s Tuition Deferment
  - Tuition: $2,400/person. Tuition includes meals and materials.
  - Special Rates: Team Advantage (if 5 or more are from the same organization) or Government Rate: $2,200/person
  - Units: 1.0 Degree-Bearing Units for Business Administration from an Accredited University (Pacific College is a WASC Accredited University. The course totals to 1.0 Accredited Degree-Bearing Units. These degree units are transferable to degrees at other colleges and universities, dependent on their process.)
  - Earn a Certificate of Completion
  - Transcript with Letter Grade & Receipt for Tuition
2. Direct Budget/Payment
  - Tuition: $2,400/person. Tuition includes meals and materials.
  - Special Rates: Team Advantage (if 5 or more are from the same organization) or Government Rate: $2,200/person
Are you registering using the Tuition Assistance/Deferment, Financial Aid & Voucher OR Direct Budget option?*
1. Tuition Assistance/Financial Aid/Deferment
  - Click on this link to download the Financial Aid/Tuition Deferment form if you are using Tuition Reimbursement.
  - Once you've filled your Financial Aid/Tuition Deferment form out completely, please upload your form below. Make sure you have completely filled it out before uploading.
2. Tuition Assistance using Voucher
  Kindly note to send us a copy of your voucher after completing the class for invoicing purposes.
IMPORTANT NOTE: RTX employees need not submit a tuition deferment form.
Upload Financial Aid/Tuition Deferment Form/Voucher

Cancelof
Please select Ticket Type below*

For yourself, $2,400 billed via PayPalTeam Advantage, $2,200 each, billed via PayPal (if 5 or more are from the same organization)Government Rate, $2,200 each, billed via PayPalRTX Rate, $2,200 billed via PayPal
PayPal Invoice: please indicate the email address we should use to send the invoice.*
Name*

First NameLast Name
Middle Name
Prior Last Name
Job Title*
Company/Organization*
Mobile Phone*
Home Phone
E-mail Address*
Any Dietary Restrictions?*
SSN or ITIN*
Birth Date*

MonthDayYear
Work Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Your Preferred Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
Are you an ERG/Affinity Group/BRG member?*

YesNo
Which group(s) are you a member of?*
Would you like to share your LinkedIn profile with the group?*

YesNo
Please include the link to your LinkedIn profile, so that you can stay in touch with the group via LinkedIn after.*
Was there a specific person who referred you?*

YesNo
Please include the name(s) below:*
How did you hear about the program?
Should be Empty:

El Segundo Charisma & Context Registration Form