Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Participant Mobile Number *

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Parent / Guardian Name *

First Name

Last Name

Parent / Guardian Mobile Number *

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Sessions *

Check all sessions you are registering for

Executive Functioning and Self-Management (Virtual) 3/17, 3/24, 3/31 & 4/7

Internal Validation 4/23, 4/30, 5/7 & 5/14

Payment Agreement *

I understand and acknowledge that by registering for this workshop, I am making a "purchase," and I am responsible for the $400.00 per-session registration fee to Design & Align LLC.

Agreed

Are you interested in receiving information regarding upcoming workshops?

Yes

Are you interested in attending a parent workshop?

Yes