REGISTRATION

COACHING A PASSIONATE GENERATION

REGISTER NOW!

Registration Form

Please fill out this form in its entirety so we can accurately process your registration.

Full name of person responsible for payment *
Full name of participant (if different from above)
Please choose the grade level of the participant:
Street address (ex. 123 Main Street) *
City, State, Zip Code *
Phone number (555-555-5555) *
Email address *
Are you participating in a school program?
Name of school (if applicable)
Choose your program:
How would you like to pay?:
Disclaimer**	I hereby agree to the terms and conditions set forth and verify that I am at least 18 years of age

Once you submit your registration, you will be directed to a secure payment location to complete your order.

1. Choose the DirectionNOW Program you want
2 . Click add to cart
3. Complete your payment

If you are paying by check, please make checks payable to:

Convergence Point
Ste. 213
411 West River Road
Elgin, IL 60123

**Disclaimer** I agree to take responsibility for results and actions associated with the DirectionNOW program. The material and the coaching aspects of the Convergence Point and DirectionNOW are guides for my own self-discovery and decision-making process and my parents understand and agree to that as well. I have their full permission to participate. Convergence Point, Inc. does not accept responsibility for decisions you make before, during, or after completing the DirectionNOW. By checking this box, I am agreeing to take full responsibility for my actions that in any way could be construed to be connected to DirectionNOW and agree to release Convergence Point, Inc. and its owners, employees, and coaches from all liability for your actions. By registering here you are agreeing to these terms.