Dec 9, 2019, 22:36

Individual Registration

Please enter information in the form below to process your registration for the Leadership Conference Individual.

First Name *

Last Name *

Organization *

Address *

City *

Zip *

Country *

State *

Phone *

Email *

Master Classes

Lobster Boat Tour #1 3:00 p.m. - $25

Lobster Boat Tour #2 3:30 p.m. - $25

Shipyard Brewery plus beer/cheese pairings - $25

Beginner Chocolate Session (morning) - $25

Advanced Chocolate Session (afternoon) - $25

Payment Information

Amount

$

Payment Method *

Authorize.net Please Bill Me

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Type*

Card Holder Name*