Registration Form
Collaborative Learning Solutions, LLC
C5 Summer Institute @ Pechanga Resort Temecula, CA
June 20-21, 2019
Registration Deadline: June 4, 2019

The cost is $399/person and for a group of 4 or more $375/person. This cost includes registration for two days, materials/books, continental breakfast and lunch on both days. This institute has valuable information and strategies for ALL staff working with students with emotional and behavioral needs, such as teachers, IAs, behavior specialists, program specialists, principals, school psychologists, etc.

Email address *
District Name *
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Contact Person *
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Contact Person Phone Number *
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Contact Person Email Address *
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Attendee 1 Name *
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Attendee 1 Email Address *
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Attendee 2 Name
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Attendee 3 Name
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Attendee 4 Name
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Attendee 4 Email Address
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Name *
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Email *
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Phone Number *
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Billing Address *
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Payment *
For P.O. Payment Option: Please provide P.O. number, contact name, and email
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1. Payment Options
a) If you are paying by Paypal, thank you for your payment.
b) If you chose to pay by "check" or "purchase order" please make sure Collaborative Learning Solutions receives the appropriate payment or documentation ONE WEEK PRIOR TO THE EVENT TO RESERVE YOUR SPACE.
c) Please make sure your check or purchase order is made payable to: Collaborative Learning Solutions. (Mail to: 43426 Business Park Drive, Temecula, CA 92590) Attn: Candy Haight or email to

a) Please be advised, in the case of insufficient funds, a fee of $35 will be charged over and above full cost of the event.

a) Cancellations made in writing prior to the registration deadline will be eligible for 100% refund. Cancellations done after the registration deadline will NOT be refunded. You may transfer your ticket to another participant if requested is in writing two days prior to the event. Please send all written communications to

a) Funds will be refunded at 100% only if cancellation request is received in writing before the registration deadline. Refund requests should be sent to

The above information is true to the best of my knowledge. I authorize payment to be maid directly to Collaborative Learning Solutions, LLC. I understand that I am financially responsible for any balance. I also authorize Collaborative Learning Solutions, LLC to release any information required to process funds. *
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