Name First: __________________________   Name Last: __________________________                                          

 Designation (CPSI,  CPRP, etc.) ___________________________

 Job Title: _________________________  Name of Organization: _____________________

 Street Address: _____________________  City, State and Zip: _______________________

 Registrant Cell Phone: _____________________ Registrant Office Phone: _______________

 Registrant E-mail: _______________________  Supervisor's E-mail: __________________

 Supervisor's Cell Phone (for those with shared computers): _____________________________

Do you want continuing education units?  __________  If yes, we will contact you.

Do you require learning accommodations? __________ If yes, we will contact you about large print materials. Request due by September 15, 2020, or we may not be able to accommodate you.  

Cancellation Policies: Cancellations before September 30, 2020 will be eligible for a refund. No refunds after October 1, 2020. We can place you in another class within the following 6 months. All cancellation requests must be submitted in writing by email to playsafe@play-safe.com

I certify by my signature below that I understand PlaySafe,LLC registration, cancellation and learning accommodation policies.

Signature here: _______________________________________                                                                

Date:  _________________________________

Registrations are accepted until full—we do have a capacity.

 Please check applicable boxes

Individual Registration Fee—one link/one CEU/one Guidebook for self-printing provided: $95.00 o

Group Registration Fee of UP to 10—one link/one Guidebook for self-printing: $195.00* o (use a meeting room with good audio, a large screen and laptop for a group learning experience) *

*includes proof of training attendance and 0.3 CEU fee for up to ten

Payment method:      o Credit Card   o EBT        o I will send a check

oPurchase Order # ___________________________Contact Name___________________________

We will send an invoice for direct credit card and EBT payments within 5 working days of receiving your e-mail.

OR 

Mail Checks and Registration form to:

PlaySafe, LLC

PO Box 66056

Albuquerque, NM  87193

CEUs provided by:

Logistics for our Academy

• Computer or phone required. Be sure to charge your device.
  
• Class is more fun if you have a camera and microphone and you type into the chat box.
  
• MDT Time Schedule
  
• October 15, 2020 - 7:45 to 8:00am Check-in, Welcome & Use of Technology
  
• 8:00 to 11:30 pm Workshop

Day of Registration

Call 505.899.9532. We have technical requirements to send you in advance and you may not receive them prior to class. Registration is limited. Pre-register.