SOAR Coordinator Course Registration
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1.
Coordinator Course Date
(Required.)
January 16th, 2025, at 12:00 pm EST via Zoom
April 3rd, 2025 at 12:00 pm EST via Zoom
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2.
Course Participant's First and Last Name
(Required.)
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3.
Course Participant's Email Address
(Required.)
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4.
Course Participant's Phone Number
(Required.)
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5.
Course Participant's Discipline
(Required.)
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6.
Lead Coordinator's First and Last Name
(Required.)
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7.
Lead Coordinator's Email Address
(Required.)
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8.
Lead Coordinator's Phone Number
(Required.)
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9.
Billing Contact's Email Address (If applicable)
(Required.)
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10.
Please list your hospital, foundation or nonprofit affiliation
(Required.)
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11.
By checking the box, I acknowledge that payment for the course is due 2 weeks prior, and the participant will complete all the pre-course work on time, in order to attend the course.
(Required.)
I understand
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12.
I understand that payment for this course, pays for a slot on the selected date ONLY. Payment is not transferable or refundable. Please contact the Phoenix Society if further discussion is needed.
(Required.)
I understand
