New Class Registration Class: Pro-ACT Training - Burlington, VT Training Date: Dec 9, 2019 - Dec 12, 2019 Restraint Training Date: Dec 13, 2019 Class Option --SELECT OPTION-- --- Early Registration Discount Options - MUST BE PAID BY Nov 15, 2019 ---Pro-ACT Training Certification - EARLY DISCOUNT OPTION - $1,385.00Pro-ACT Training + Pro-ACT Restraint Certification - EARLY DISCOUNT OPTION - $1,735.00--- Registration Options - PAID AFTER Nov 15, 2019 ---Pro-ACT Training Certification - $1,485.00Pro-ACT Training + Pro-ACT Restraint Certification - $1,835.00 CEUs Available ProACT: BRN Restraint: BRN Fees Due Class Registration Fee$0.00 CEU Options$0.00 Total Due$0.00 Class Registrant Information The "Registrant" information below *MUST* be completed for the student - providing information specific to the person attending the training. The Email address must be unique for the Registrant. (ALL fields are required) Registrant Email: * Confirm Registrant Email: * First Name: * Last Name: * Position: * Agency Name: * Secondary Email: Home Address: * City: * State: *--Select a State--Alberta, CanadaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingIncheon, South Korea Zip: * Day Phone: * Cell Phone: * Supervisor Name: * Supervisor Phone: * * - required field Profile Admin Information (optional) The Profile Admin, if defined, will have the ability to access the Registrant's profile as a way of providing support. This person will receive copies of all email correspondence sent to the Registrant / In-Service Instructor. Profile Admin Email: Confirm Profile Admin Email: First Name: Last Name: Payment While payment may be made by check, your class registration is not reserved and you will not have access to additional class information until payment in-full is received. Payment by credit card may be made on the following page and confirms your registration immediately. REALLY Important Info: Verification To confirm that you're a living, breathing human - please enter the text characters displayed in the field below. The code will be validated automatically. Enter Code Here: Status: Pending Refunds and Dismissal Policy Review and Acceptance The Pro-ACT, Inc. Refunds and Dismissal Policy may be reviewed by clicking HERE. By checking this box , I certify that I have read and understand the Pro-ACT, Inc. Refunds and Dismissal Policy. Submit Registration Press the buttom below to submit the Registration data. You will be directed to the Payment page, where you will complete the payment transaction. You will receive an Email to confirm that we've received your information, along with further instructions.