REGISTRATION: Self-Paced, On-Line Certification

• • Today's Date*
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  • I am registering for:*
    Please select the training event that you are registering for.
    
    Note: Prerequisites are required and some conditions apply for Level 2 courses.
    >Choose a trainingAdministrator/Leader (Level 1 or 2) Certification TrainingTrain the Trainer (Level 1 or 2) Certification TrainingBOTH: Administrator/Leader (Level 1 or Level 2) Certification and Train the Trainer (Level 1 or Level 2) Certification
  • Acknowledgments*
    Check each box to agree: If any of the following statements presents an issue for you, you may find it difficult, or be unable, to complete the course.
    I understand this is an on-line, self-paced course.

    I understand I have 12 weeks (8 weeks for Level 2 courses) to complete the course and assignments.

    I have at least basic knowledge and computer skills (especially for Internet, Email, Word, and PowerPoint).

    I understand this course is in English, and acknowledge I am capable of communicating/submitting assignments in English.
  • Your Name*
    First Name

    Last Name
  • Personal Address*
    Please fill in your personal address, your organization's address is requested later.
    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*
  • Your Email*
     
  • Your Personal Phone Number*
     
  • Preferred Language*
    >EnglishFrenchBilingual
  • Organization Name*
    Name of the organization that you are working for/volunteering at.
  • Address of Organization*
    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's 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% discount 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

    Unsure
  • 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 hard copy of the Plan to Protect® Manual (2010 ed. or newer)

    I need to purchase a hard copy of the Plan to Protect® Manual
  • We would like to gift you the PlantoProtect App*
    Select the phone which you would like us to provide you the app on.
    >Select OneiPhoneAndroidOther - at this time, the app is only available for iPhone and Android users
  • Email for PlantoProtect App*
    Please indicate the email associated with your phone app account:
    >Same as aboveOther
  • Email for PlantoProtect App
    If different than above, please provide the email address for us to send the app to:
  • 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?
• Consent

  For our Canadian Clients: With Canada's anti-spam legislation we are required to obtain your consent to send you electronic communications. We do need express permission from each individual within an organization that we are communicating with.
  
  You may unsubscribe or withdraw your consent at any time by contacting us at Plan to Protect® 117 Ringwood Dr., Unit 11, Stouffville, ON L4A 8C1, or emailing us at info@plantoprotect.com.
  • Please confirm your consent to receive electronic communications from Plan to Protect® as described above. This consent will be considered as consent of the registrant.
    Yes I give my consent for all e-communication

    Yes I give my consent for Monthly e-Newsletters only

    No I do not give my consent
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