CPE Program Registration – CPE Certified Port Executive™ Program

CPE Program Registration Form:

Participant Information

Name (required) *

Position/Job Title (required) *

Company/Organization (required) *

Address (required) *

City (required) *

State or Province (required) *

Country (required) *

Zip or Postal Code (required) *

Business Phone (required) *

Office or Mobile Phone (required) *

Email (required) *

Website

Preferred Class Date *

Date Registration Submitted (Todays Date) *

Payment Details - We also except: Check, Purchase order is required Direct Deposit EFT (Electronic Funds Transfer) Payment

Please note the form below "does not" validate credit card numbers, please type in the fields correctly or contact us to make payment arrangements. If you want to use another payment method contact us at registration@macdonnell.com or call us 1-866-219-6563

Registration Amount

Select Your Card Type

Card Number

CVV (3 Digit Number)

Expiry Date

Card Holder Name

First

Last

Card Holder Zip or Postal Code

Card Billing Address

Comments

How did you hear about us? (required) *

Please select an option from the drop down menu

Add Your Twitter Address

Add Your LinkedIn Address

CARD OWNER AGREES TO PAY TOTAL IN ACCORDANCE WITH AGREEMENT GOVERNING USE OF SUCH CARD | INTERNATIONAL TRANSACTIONS MAY BE SUBJECT TO AN ADDITIONAL CURRENCY CONVERSION FEE | CHARGE BACKS AND DECLINED TRANSACTIONS MAY BE SUBJECT TO AN ADDITIONAL HANDLING FEE | MACDONNELL RESERVES THE RIGHT TO RE-SCHEDULE COURSES, CANCELLATIONS WILL BE CARRIED FORWARD TO THE NEXT AVAILABLE COURSE IN THE REGION, NO REFUNDS.

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