Co-Parenting Seminar Rescheduling

Rescheduling Seminar Dates

Complete this form to reschedule to your preferred seminar date.

Full LEGAL Name(Required)

Please list your full LEGAL name including your first, middle, and last name as you would like to see it on your Seminar's Certificate of Achievement.

Maiden Name if Applicable

Preferred Email Address(Required)

Mailing Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Preferred Phone Number(Required)

Preferred Seminar Date(Required)

Original Seminar Date(Required)

Rescheduling Fee

Price:

FULL name on the debit/credit card:(Required)

Authorization is needed for cards with a different name than that of the individual registering for the seminar.

Contact phone number of cardholder:

Authorization is needed to process the transaction if the cardholders name is different than that of the registering individual.

Credit Card(Required)

Card Details

Cardholder Name

CAPTCHA

Total

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Rescheduling Seminar Dates

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