Course Enrollment Form Website Registration plus Course Enrollment Use this form to create a new, free account on this website AND at the same time register and pay for this course. Please fill in the form and choose which course you would like to purchase, then indicate your preferred payment method. INSTRUCTIONS To use by Credit or Debit Card, enter your card information through our secure checkout form; your payment will be processed immediately after you click the REGISTER button. If you choose PayPal, after clicking REGISTER you'll be taken to PayPal, where you may use your PayPal account. After completing the payment, you will return to this website page and see a confirmation message. You'll receive an email confirmation of your registration payment, along with a separate email with your account info including username and password. As soon as you receive your account info, you may login to the site and start the course at your convenience. If you have any questions or need assistance, please email John Hamel at email@example.comName* First Last Email* IMPORTANT NOTE: If you already have a user name and password for this site, please login FIRST in the sidebar, then this page will display a slightly different course registration form specifically for returning users. [If you try using this form with your name and email address and are already registered on the site, you will get an error message because it is trying to create a NEW user account. To avoid this issue, please login using the sidebar form.]Domestic Violence Training Course*Choose your course below:[DV1] Domestic Violence Worldwide - $75[DV2] Evidence-Based Treatment of Intimate Partner Abuse, Part 1: Research, Theory and Assessment - $125[DV3] Evidence-Based Treatment of Intimate Partner Abuse, Part 2: Treatment - $125[DV4] Domestic Violence: Contemporary Research and Criminal Justice Responses - $75[DV5] Domestic Violence and Child Custody - $75[DV6] Intimate Partner Abuse Assessment - $75[DV7] Working with Victims: Best Practices - $75Discount Code (optional)Enter your coupon code here for discount on course registration.ADVIP Member Discount - DV1 Price: -$30.00 Discount for current ADVIP membersProfessional Discount - 30% Price: $0.00 Discount for mental health and domestic violence professionalsPromotional Discount - September 2017 - FREE Price: $0.00 Free registration this month for mental health and domestic violence professionals!Student Discount - DV1 Price: -$15.00 Student DiscountStudent Discount - DV2 Price: -$25.00 Student DiscountStudent Discount - DV3 Price: -$25.00 Student DiscountStudent Discount - DV4 Price: -$15.00 Student DiscountStudent Discount - DV5 Price: -$15.00 Student DiscountStudent Discount - DV6 Price: -$15.00 Student DiscountStudent Discount - DV7 Price: -$15.00 Student DiscountTotal $0.00 Payment Method*Please choose your preferred payment method below:Credit or Debit CardPayPalThis page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.