Registration - 2021 Mastery Training: January 4-13, 2021

First Name *

Last Name *

English Name

Organization/Country contact

Address 1 *

Address 2

City *

State/Province *

Postal/Zip Code

Country *

Home Phone *

Business Phone

Email Address *

Registration Date (MM-DD-YYYY) * +

2021 Mastery Program

My contact details may be shared with other participants in the Mastery Program *

Yes

Method of Payment: Tuition and translation fees (if requested) are due six weeks before the event (by November 23, 2020). If we do not hear from you earlier, we will process your balance due on the credit card you provided at registration. IF YOU DO NOT MAKE YOUR PAYMENT IN FULL AT LEAST FOUR WEEKS PRIOR TO THE EVENT, WE MAY RELEASE YOUR SEAT AND HOLD YOUR DEPOSIT FOR A FUTURE EVENT (within one year). *

Update Credit Card Information	Process credit card for $4200 USD
Process credit card for $500 USD deposit	Other Other

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (MM/YY)

CVV#:

Name for your name badge:

Name for your certificate:

The Mastery Program is for graduates of the Psychology of Vision 100 Day Graduate Program. Have you completed the PoV 100 Day Program? *

Yes, I have completed the 100 Day Program.

No, I have not completed the 100 Day Program.

Some applicants may be asked to improve their skills in joining before attending the program.

Translation: Translation services may be offered on availability of a translator and the number of people requesting translation. The fee is dependent on the number of people requesting translation and will also be due six weeks prior to the event. *

German

Mandarin

Japanese

None

Thank you for registering!