Virtual CCI-USA Int'l Workshop 2023 Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Registration has ended. Please do not submit this form unless requested to do so by a member of the org team.

Payment info:

Checks made out to CCI-USA to Paula Lindsay, 17 Knollwood Dr., Vernon, CT 06066.

Paypal to treasurer@cci-usa.org

$70 East and Central Time Zones USA, $40 West and Mountain Time Zones USA, free for international participants, donations welcome.

First name *

Last name (family name) *

My preferred pronouns (optional)

My email address is *

Best phone number to reach you (include country code if it's not a U.S. number) *

Can you receive texts on this number? *

Yes

Other:

Mailing address - number, street, apartment, etc. *

City, state, zip/postal code, etc. *

Country *

We typically share participants' contact info with other workshop participants (for co-counseling purposes only). We share city, state, and country. May we also share: *

Yes

Your email?

Your phone number(s)?

Clear form

Never submit passwords through Google Forms.

This form was created inside of CCI USA. Report Abuse

Forms