Campus Impact Online Registration

• Please provide the following information:

  First Name
  Last Name
  Title
  School or Organization
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Country
  Work Phone
  E-mail

            Certificate Req'd Select one..... TOLEDO ONLY:  CEU provided by Community Partnership at no add'l TOLEDO ONLY:  RCH certificate provided by Community Partnership no add'l fee Certificate of Participation (included, no charge) CEU Certificate (add $10 to registration cost) RCH Certificate (add $10 to registration cost)  

            Payment Type Choose one.... Please bill me, I will pay with a check Please bill me, I will pay with a purchase order Credit Card/Paypal

            Additional information

            Required:  What is 5 + 6? (Prevents spam)

By submitting this form, you agree that:   Cancellations must be received in writing and received no less than 15 days prior to the event for a refund. No refunds for cancellations received less than 15 days prior to event.   If an event is cancelled due to weather, your registration will be applied to the the make up event date.  No refunds for non-attendance if event is not cancelled by Campus Impact.  Campus Impact reserves the right to cancel an event with 3 days notice due to insufficient confirmed registrations or other reasons beyond our control, in which case, your choice of a full refund or credit towards future events will be provided.