On-Line Course Registration Form
PDC Option
Characteristics of Individuals Who Learn Differently
by Dr. Richard Cooper

Please complete and submit the form below. After your registration has been processed, you will
receive a confirmation e-mail that will include your link to the course along with other course information.
Please Note:
If you do not receive your confirmation email within two days, please contact us
by email at
[email protected]

Contact Information
Required Information fields are Bold Faced
All required fields must be completed for the registration to be processed.
First Name:      
Middle Initial:
Last Name:
Address Line 1:
Address Line 2:   
Zip Code:
Phone Number: -
Fax Number: -
Professional Information
Educational Position:
Student Status:
Professional Development Center:
Educational Background:
Reason for taking course:
Please review your information before submitting the Registration Form.

If there is an error Click the Reset Form Button and re-enter your information.

If your information is correct, click the Submit Form Button.
After clicking the Submit Form Button a screen will come up showing the information you entered. This verifies that your registration has been submitted.