Mnaeyc-Mnsaca Training

MnAEYC-MnSACA Training

Group Registration Form

This form is to be used only if you are registering 2 or more people for a training. This form must be submitted to at least 5 business days prior to the training date, or each individual will be required to register separately at .

A separate form must be completed for each training you wish to register for.

Please note that an email address, preferably a personal one, is required for each registrant as this is how we communicate about updates to the training, track attendance, and provide training certificates.

*Name of Training:

*Date(s) of Training:

Program Information

Name
Street Address
City / State / Zip Code

Billing Contact

Please provide contact information for the person at your program who would be responsible for processing payment. A MnAEYC-MnSACA representative will contact the person you list in order to process your registration fees.

Name
Phone / Email

Primary Registrant

Primary Registrant Name / Develop ID
Email / Phone Number
Current Membership StatusTraining Registration Fee ☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)

Additional Registrants

Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)
Name / Email / Develop ID
Current Membership Status & Training Registration Fee
☐MnAEYC member ($60) ☐MnSACA member ($60) ☐Non-Member ($75)

Total Registration Fee: $