New England Basecamp: RIDE Endorsement Course

Individual Registration : Contact Information
Participant First Name*
Please use the name you would like printed on end of course certification documents.
Participant Last Name*
Please use the name you would like printed on end of course certification documents.
Phone *
Enter your preferred phone number for receiving course-related calls. Format: (XXX) XXX-XXXX
Email*
Enter your preferred email for all course related correspondence. This can be a personal or professional email.
District*
If you selected "Charter School" or "Other" for district, please indicate the name below
School *
If you work across multiple school settings (e.g., OT, SLP) please write in the name of your primary setting/school. If you work in a district-level position or outside of a K-12 school building please enter N/A
Position *
If you selected "Other" for position, please indicate your position below
Accommodations Request:If you would like to make NEB facilitators aware of any accommodations, such as assistive technologies, that benefit you and your learning, please let us know here.
How will you be paying for this course?
If you registered for the SELWhich Cohort are you registering for

Group Registration : Contact Information
Your Full Name*
Name of person responsible for registering the group
Phone *
To contact for group registration questions, Format: (555) 555-5555
Email*
Email to contact for group registration questions
District*
If you selected "Charter School" or "Other" please type it below

Invoicing Information

If you are paying for the course yourself please enter your information below, if your School/District is sponsoring your participation please ensure that you have the correct information for the School/District to be invoiced.
Invoice School/District Name*
Name of school/district to address the invoice, if paying yourself please write N/A
First Name (for invoicing)*
Name of person to address the invoice to
Last Name (for invoicing)*
Name of person to address the invoice to
Invoice Email*
Email to send invoices to
Invoicing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Group Registration: Participant Information

Please ensure that you register each participant by clicking "+Add Row" for additional spaces.
Group Registration*

Payment Information

My Products

SEL ENDORSEMENT COURSE

For Group Registrations: Please ensure you select the quantity that corresponds with the number of participants you are registering. Group pricing register 5 get the 6th participant free!

$2,200.00 Quantity
Item subtotal:$0.00

PreK-5 STEM Endorsement Course

$1,800.00 Quantity

Enter coupon

Total

$0.00

Email
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Please read and check to affirm the following statements.*

Course Requirement Acknowledgements
Check to acknowledge you have reviewed and agree to each requirement.*
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New England Basecamp: Endorsement Course Registration

Individual Registration : Contact Information

Group Registration : Contact Information

Invoicing Information

Group Registration: Participant Information

Payment Information

Course Requirement Acknowledgements