Certification Training Registration Form

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  • Your Name*
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  • Address*
    Please fill in your personal address, your organization's address is requested later.
    Street Address*

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    Country*
  • Your Email*
     
  • Your Personal Phone Number*
     
  • Preferred Language*
    >EnglishFrenchBilingual
  • Organization Name*
    Name of the organization that you are working for/volunteering at.
  • Organization Address*
    Please fill in your organization's address.
    Street Address*

    Address Line 2

    City*

    Province / State / Region*

    Postal Code / Zip

    Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

    Country*
  • Organization Phone Number*
     
  • Your Title or Role
  • Status*
    >Full TimePart TimeVolunteer
  • Organization Website
     
  • Organization Type*
    Please select the type of organization that best describes the organization you are registering under.
    >BusinessNot-for-ProfitChurchSchoolCampSporting ClubMinistryDenomination OfficeInsurance CompanyIndependent Instructor
  • Denomination & Referral Partners*
    Licensed denominations qualify for a 10% dcount on services of Plan to Protect®.
    >Christian & Missionary AlliancePentecostal Assemblies of CanadaPentecostal Assemblies of Newfoundland & LabradorEvangelical Missionary Church of CanadaFellowship of Evangelical Baptist Church of CanadaEvangelical Free Church of CanadaAnglican Network in CanadaSociety of Saint Pius XCanada Central District - Nazarene Church in CanadaUnited Church in CanadaFree Methodist Church in CanadaCanadian Conference of Mennonite BrethrenChurch of God in Eastern CanadaOther (no discount applies)
  • Name of Director/Senior Pastor/Principal*
  • Email of Director/Senior Pastor/Principal*
     
  • Plan to Protect® Membership Status*
    Yes we are a member

    No we are not a member

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  • Required Text (not included in the registration fee) - Plan to Protect® Manual (2010 ed. or newer) Hard Copy*
    Additional shipping charges may be applied.
    I have a copy of the Plan to Protect® Manual (2010 ed. or newer)

    I need to purchase a copy of the Plan to Protect® Manual

    Unsure
  • Knowledge of Plan to Protect®*
    >I know Plan to Protect® well.I'm moderately familiar with Plan to Protect®I'm new to Plan to Protect®I'm re-certifying my Plan to Protect® training
  • Who may we thank for referring you to Plan to Protect® Certification Training?
  • How would you like to pay for your course(s)?*
    Credit Card (I will call your office to pay)

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    PayPal (email me a PayPal invoice)

    Email Transfer (via online banking)

    This training is included in my Implementation/Going the Distance membership
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