Hawaii test

Hawaii 2022 new form

"*" indicates required fields

Step 1 of 2

Choose Playshop*

NOTE: In order to have your form submit successfully, please be sure to enter correct information in each field with an asterisk(*) as well as your credit card information with expiration date and code at bottom of form. If it doesn’t work first time, try again with another credit card.

Your Information

Name*

First Last

Gender*

Male

Female

Nickname

Address*

Street Address Apartment or PO Box City State / Province / Region ZIP / Postal Code Country

Email*

Home Phone*

Mobile/Cell Phone*

Organization

Registration

Lodging*

Double - shared with 1 other
Triple - 3rd person gets cot
Camping - bring own tent & bedding

Roommate Preference

Name of preferred roommate, if any

Meal preference*

Discount (only one per participant)

No discount

$150 VMC Certified Facilitator

$250 VMC Global Trainer

Educational credits

Continuing Education Credits (CEU)

I would like to receive Continuing Education Credits

Type of CEU's

*$80 processing fee
♦ additional fees apply, we will contact you to complete processing.

CMT Number*

Profession*

Training

Goal for attending

How did you hear about us?

List VMC trainings attended

Lodging option: Double

Lodging option: Triple

Lodging option: Camping

Hawaii Mentor Fee

CEU Processing

VMC Certified Facilitator Discount

VMC Global Trainer

Total Due

Payment Option

$500 deposit

Pay full amount now

Hawaii Playshop Deposit

Price:

Hawaii Playshop Full Amount

Price: $0.00

Total Due Today

Credit Card Address*

Credit Card Address is the same as mailing address above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Uncheck if credit card address is different from address entered above

Credit Card

Card Details

Cardholder Name

This field is for validation purposes and should be left unchanged.