Individual Registration

Please enter information in the form below to process registration for event ONLINE - Word to the Max 10/16-17/23 (2 day class).

First Name *

Last Name *

Organization

Address *

Address 2

City *

Zip *

Country *

State

Phone *

Email *

Student Email (If Different)

Comment

Payment Information

Coupon

City/State Agencies should use code DIR14 to receive state DIR pricing. If you are NOT a state agency but registering in multiple classes use the code “save 20” to save $20 off regular price.

Amount

Discount Amount

Gross Amount

Payment Method *

Credit Card (Authorize.net) Check/Purchase Order

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*