Trained Individual Contractor Certification Registration

REGISTRATION for the TRAINED INDIVIDUAL CONTRACTOR CERTIFICATION.

TRAINED INDIVIDUAL CONTRACTOR CERTIFICATION
THURSDAY, MAY 6, 2021
9:30am – 12:30pm
ZOOM

***IMPORTANT***
We are only offer the re-certification track (the Advanced Training Track) in 2021.

REGISTRATION is OPEN

Deadline to register is the close of business on Monday, May 3.

Name*
First Last
Company*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Advanced Training Track - $50 per person
Due to Covid-19, we will only be offering our re-certification track (the Advanced Training Track).
Price: $50.00
How many total people will you be registering?*
Attendees*
Please enter the name and email address of each person attending. We will be sending an email to each registered participant that contains information on how to access the training via Zoom. Click the + at the end of the Email line to add another row.
First Name Last Name Email
How would you like to pay?*
- Credit Card
- Check
We accept MasterCard, Visa, and Discover. Please make checks payable to White River Alliance.
Would you like to cover the transaction fees?*
Your payment is securely being processed with a 3% transaction fee to cover credit card, bank fees, and other processing costs. Please consider chipping in an additional 3% so 100% of your payment goes to the White River Alliance.
- Yes, add 3% so 100% goes to the White River Alliance.
- No, do not add 3%. I understand that only 97% will go to the White River Alliance.
Total Amount Due (includes 3% transaction fee)
Price: $0.00
Total Amount Due
Price: $0.00
Credit Card

Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Please make checks payable to:

White River Alliance

1052 Woodlawn Ave

Indianapolis, IN 46203
Collection Type

donate

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Donation Amount
- $25
- $150
- $500
- Other
Other Amount

transaction costs
- Cover transaction costs
Transaction costs
Your donation is securely being processed with a 3% transaction fee to cover credit card, bank fees, and other processing costs. Please consider chipping in an additional 3% so 100% of your donation amount goes to the White River Alliance.
We would like to recognize our donors by acknowledging you in our newsletter. Please let us know if you'd prefer to remain anonymous.*
- Yes, I'm fine with my gift being acknowledged by name.
- No, I prefer to remain anonymous.
Donation Amount*
Price: $0.00

First Name	Last Name	Email