ASCLD - 2022 Fall Leadership Academy Registration

2022 Fall Leadership Academy Registration

Registration for the 2022 Fall ASCLD Leadership Academy

Student Information

First name

Last name

Title

Email address

Organization

Phone

Registration Fee

Non-member ($850)

ASCLD member ($750)

Member to Non-member adjustment ($100) **DO NOT SELECT UNLESS REQUESTED BY ASCLD**

Total

Billing Information

Please select your payment method.

Debit/Credit Card

Check

Credit Card

Payment by Check
You will receive an email from office@nullascld.org to make arrangements for your payment by check. Please note, ASCLD reserves the right to cancel your enrollment from the course if payment is not received by October 1.

Billing Contact Name

Billing Phone

Billing Email

Billing Address

City

State/Province

Zip/Postal

Country

Confirmation

I or the person I am registering would like to register for the Fall 2022 ASCLD Leadership Academy and I authorize ASCLD to charge the provided credit/debit card or contact me about payment by check. If I am submitting this form on behalf of someone else, I acknowledge that I have their permission and am authorized to submit payment information on their behalf.

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