Graduate Seminar Registration Graduate Registration "*" indicates required fields 1Participant2Medical3Accommodations4Travel5Agreements6Payment Opportunity ID is required. Please check the referring link. If you need assistance, please contact us. Enrollment DetailsThis completed registration form and deposit must be submitted by the due date on your acceptance notice. If the form & deposit are not received by the specified due date, the scholarship offer and place in class will be rescinded. A completed registration and $150 refundable deposit are required before you will be enrolled in the workshop.Name* First Last Preferred Name on ID Badge Course You Are Attending Do you teach at a Title I School?* Yes No Have you previously participated in Medal of Honor Character Development Training?* Yes No Are you retired?* Yes No Participant Medical InformationGender* Male Female Medical Issues*NoneFrequent ear infectionsHeart defect/diseaseConvulsionsDiabetesBleeding/Clotting disordersHypertensionMononucleosisHepatitisOtherOther Medical IssuesAllergiesNoneAsthmaHay FeverInsect StingsIvy poisoningOtherPenicillinOther Allergies On-Site AccommodationsIf you need special accommodations for on-campus housing at Freedoms Foundation, such as a first-floor room, please note here.Special Room RequestsFirst floor or roommate requests only Will you need transportation from the Philadelphia Airport to & from our Valley Forge campus?* Yes No ArrivalArrival ModeAirBusDrivingTrainCarrier Flight # Date MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM DepartureDeparture ModeAirBusDrivingTrainCarrier Flight # Date MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM AgreementsTerms and Conditions* I agree to the policies and terms listed in the email from Freedoms Foundation.I have read & understand the FAQ info sheet and agree to the terms. I have read & understand the airport arrival and departure information and agree to the terms. I have read & understand the deposit and refund information and agree to the terms. I have read & understand the Conduct Code. Payment Method Credit Card Check or Money Order No Payment Today Send Check or Money Order to: Freedoms Foundation at Valley Forge Attn: Education Dept.-History Encounters PO Box 67 Valley Forge, PA 19481 A check/money order must be received within 7 days to successfully complete your registration.Payer InformationName* First Last Email* Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Postal Code Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Deposit Payment Price: Amount Paying Today PhoneThis field is for validation purposes and should be left unchanged.
