This form needs to be received at least 2 days prior to the start of the class.
Please print this page to fill it out
I, (please print) ____________________________ wish to register for
Preventing Classroom Discipline Problems; The Online Course
for Session #____ , which begins on:__________________.
(If signing up for an Individual Tutorial, leave above line blank and choose a start date:__________________.)
How did you hear about this course?____________________________________.
Type here a confidential Course Nickname, one that no one would know is you:_______________________.
My email address is: (print carefully)____________________________________.
My phone no. is: (_____) ________________
Enclosed is my check (or you can use
PayPal) for:
This is usually a tax-deductible, job-related expense. Your school may pay this fee; See
FAQs.
You may also pay with your credit card, securely, via
PayPal:
If you already have the book or video, be sure to subtract the correct amount
(see prices above) from your total:
After you pay, remember to come back to print and mail this page. OPTIONAL:
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I wish to apply to become a
paid Instructor of this Online Course and/or
paid Workshop Leader. Also enclosed is my separate check of $300 for
this training.
Go to
Application for Instructor/Leader
If you would like to pay by check, make it out to "Pro-Education Media" and send to:
Pro-Education
Media
c/o Prof. Howard
Seeman
20 River Court - Suite 1404
Jersey City, NJ 07310
If you need to pay using a Purchase Order you can:
• Mail it to the above address,
• Send it as an attached file to
[email protected], or
• Fax it to: (201) 420-6555.
(If you do any of the above, send an email alerting this, to
[email protected])
Check-off payment method:
_____ check enclosed
_____ I used
PayPal on: ___/___/___
_____ I have mailed/faxed a Purchase Order
*If you are not completely satisfied with the course, or find you cannot do the course satisfactorily at this time, the Registration Fee ($338)
will be fully refunded, as long as your request for this refund is received via regular mail, signed by you, within 10 days after the start-date of the course.
Please send me
confirmation of my registration via email,
and the course materials to:
Name: (print clearly)___________________________________________
Address:_____________________________________________________
____________________________________________________________
City:______________________ State:____ Zip Code:_______________
To reserve a place in the session of your choice, or to request a revision in
the course that may be better for you, email Prof. Seeman at
[email protected].
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- If you aren't, at this time, interested in the course, but wish to
purchase all or some of the materials above. Go to:
https://www.classroommanagementonline.com/~pro-ed
- If you aren't, at this time, interested in the course, but just wish to consult with the
instructor, confidentially, on a "per question fee basis". Go to:
http://hometown.aol.com/hokaja/
- If you are interested in becoming a paid Instructor of this online course and/or a
paid Workshop Leader of these skills. Click here
- I am not interested in the course now, but want information about
having an online classroom management consultant for my school. Click
here
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Any distribution of course files to non-registrants, or use of this course, whole or in part, without the permission of Prof. Howard Seeman is a violation of federal copyright laws.
Please sign:___________________________________ Date:_________________
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