2022 APPRENTICESHIP REGISTRATION

First Name *

Last Name *

English Name

Organization/Country contact

Address 1 *

Address 2

City *

State/Province

Postal/Zip Code

Country *

Home Phone *

Cell/Mobile Phone

Email Address *

Registration Date: (MM/DD/YY) *

Hawaii 2022 Apprenticeship *

Participant type *

Method of Payment: Tuition and translation fees (if requested) are due six weeks before the program. If we do not hear from you earlier, our office will process your balance due on the credit card you used at registration. IF YOU DO NOT MAKE PAYMENT IN FULL AT LEAST SIX WEEKS PRIOR TO THE EVENT WE MAY RELEASE YOUR SEAT AND HOLD YOUR DEPOSIT FOR A FUTURE EVENT (WITHIN ONE YEAR). *

Process $3,300 USD Now + Translation Fee (if requested) Six Weeks before Program

Process $500 USD Deposit Now - Balance $2,800 Six Weeks before Program + Translation Fee (if requested)

Graduate Fee - Process $1,700 USD Now + Translation Fee (if requested) Six Weeks before Program

Graduate Fee - Process $500 USD Deposit now Balance $1,200 USD Six Weeks Before Program + Translation Fee

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:

Translation: Interpretation services are offered depending on the number of people requesting translation. There will be a fee for this service (based upon number of people requesting translation). *

German

Mandarin

Japanese

None

Do you plan to graduate at the Apprenticeship? YOUR TRAINER MUST EMAIL ME TO CONFIRM THAT YOU HAVE MET THE QUALIFICATIONS TO GRADUATE. YOU WILL NOT GRADUATE UNLESS I RECEIVE A CONFIRMATION. (We kindly ask that those graduating still pay the Regular Participant rate. The 100-Day Graduate Rate is for those who have already graduated. Thank you for your understanding.) *

Yes

No

Apprenticeship Programs are on the fast track, so participants need to have at least 20 days of training in the POV model that must include 20 joining sessions and/or the recommendation of a Psychology of Vision Trainer in order to attend.

Prerequisites: *

I have completed 20 POV training days and 20 joining sessions.

I have not completed 20 POV training days and 20 joining sessions.

I am unsure if I have completed 20 POV training days and 20 joining sessions.

If you have not completed the prerequisites or are unsure if you have completed the prerequisites, you may register and then add additional days and/or joining sessions to prepare for the Apprenticeship Program. Please communicate with the trainer(s) in your area or email the Hawaii Office at Hawaii@chuckandlencyspezzano.com.

Choose the sessions you plan to attend: Students can attend one or both of Chuck’s sessions but must attend all of Lency’s to get certificates. *

Chuck: 9:00 AM to Noon Daily

Chuck: 3:00 to 6:00 PM Daily

Pending: 9:00 PM to Midnight Daily

The trainers I work with most often are: *

If this is your first enrollment at an apprenticeship program, which local trainer did you contact to support your participation? *

Thank you for your registration

Alex Patchett-Joyce	Babs Stevens	Bernadette Demens	Chisato Matsuoka	Doris Huang
Emiko Takano	Emily Chu	Francine Gerard	Franklin Fan	Gerd Kuhnen
Hiromi or Hideaki Kurihara	Joyce Cheng	Kaori Yoshinaga	Linda Li	Mami Yoshida
Mark Albas	Mina Yamato	Naoko Tokahashi	Peter Lo	Silvia Stiessel
Susanne Ernst	Tiffany Robinson	Torsten Konrad	Ute Baues	Ute Wiemann
Veron Lim	Yilung Chen