Registration Form

Please complete the registration form below.The following questions will help us to understand the needs of our audience in advance.
  

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* 1. Personal Information

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* 2. Current Position:

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* 3. Previous Position

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* 4. Rank the importance of the following in your work:

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* 5. In which of the following areas are you seeking to gain new skills? Choose as many as may apply.

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* 6. With which target audience do you plan to use the LivingSidebySide® training?

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* 7. Please upload a resume if available.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 8. Please upload other documentation if available (e.g recommendation letters from schools, churches, or a specific program you attended in the past).

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 9. What new goal do you hope to accomplish in your profession in the next five years?

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* 10. Photo/Video Release

I hereby grant Legacy International (LI) non-revocable permission to capture my image and likeness in photographs, videotapes, motion pictures, recordings, or any other media. I acknowledge that LI will own such images and further grant LI permission to copyright, display, publish, distribute, use, modify, print and reprint such images in any manner whatsoever related to LI. I further waive any right to inspect or approve the use of the image by LI prior to its use. I forever release and hold LI harmless from any and all liability arising out of the use of the images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the images, including without limitation, claims for invasion of privacy rights or publicity.

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* 11. I am registering for the following program:

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* 12. I am interested in the following program for 2022:

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* 13. Payment will be made in the following way:

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* 14. I am paying:

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* 15. Tuition payments for four or nine day programs minus $200 non-refundable registration fee will be returned if: 1) the program is cancelled due to lack of registration, or US government/Center for Disease Control guidelines,
2) the applicant withdraws or fails to receive a US travel visa by June 15, 2021.
Between June 16 to June 29, Legacy will return tuition payment minus a $800 penalty only in the case of illness or other event outside applicant’s control, if explained in writing.  After June 30, no refunds will be made.
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Fees for Group Services rendered in Nigeria by Stella Abuah are in addition, consult her directly for more details.

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