MAAP Virtual Registration Form

Name*
First Last
Address*
Street Address City State ZIP Code
Phone Number*
Email*
Enter Email Confirm Email
Referral Source*
- Judge – specify below
- Self – Referred
- Attorney
- Other
If Court-referred, please enter the name of the judge, the courthouse, and the Family File or Docket #. All three items are required if court-referred.
MAAP Virtual Class Quantity*
Price: $100.00
Program fee is non-refundable.
Total
$0.00
Select Dates*
All classes are held from 6:00pm – 8:00pm.
E-news sign up
- Yes! I want to receive DRC e-news!
By checking the box above, I agree to subscribe to DRC e-news which will be sent to my email address above. I understand that I may choose to unsubscribe at any time. DRC does not exchange, rent or sell its mailing list to any outside organization.
TERMS OF REGISTRATION: (A) an email will be sent to address provided with registration confirmation and instructions for attending class; (B) No reminders provided prior to class start date; (C) Notification required 48 hrs prior to date of first class if unable to attend; $15 rescheduling fee will apply for each date change; (D) Failure to attend scheduled class forfeits any money paid.*
- I have read, understand and agree to above terms by typing my name in signature box below.
Signature – Type name in box*
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