Victim Assistance Program · The Essentials Registration & Payment Form

The Essentials Registration

How did you hear about us? *

Who specifically told you about The Essentials?

How will participants be joining us? *

PLEASE NOTE: January and October 2025 courses will be instructed virtually via Zoom. May and August 2025 courses will be instructed in person in Akron, Ohio.

Which course are you registering for? *

Please let us know if any accomodations are required.

Purchaser Contact Information

If you are registering and paying for yourself (or others), please provide your information below.

Organization/Employer

Purchaser's Name *

First Name

Last Name

Email *

Verify Email *

Mailing Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone *

Course Fees

If you have a discount code, please enter it below.

Essentials Full Price	Quantity
$495 - Registration Fee

Essentials 25 percent off	Quantity
$371.25 - Jan 2025 Discount

Essentials Half Price	Quantity
$247.50 - Half Price Registration Fee

Course Participants

Please include the names of those who are registering for the course. In addition, valid email addresses are required for individual participants as each will be required to log into a Learning Management System to complete required course work.

How many people are you registering for? *

1) Participant *

First Name

Last Name

1) Email *

Verify Email *

1) Ohio CE License # if applicable

2) Participant

First Name

Last Name

2) Email *

Verify Email *

2) Ohio CE License # if applicable

3) Participant

First Name

Last Name

3) Email *

Verify Email *

3) Ohio CE License # if applicable

4) Participant

First Name

Last Name

4) Email *

Verify Email *

4) Ohio CE License # if applicable

5) Participant

First Name

Last Name

5) Email *

Verify Email *

5) Ohio CE License # if applicable

6) Participant

First Name

Last Name

6) Email *

Verify Email *

6) Ohio CE License # if applicable

7) Participant

First Name

Last Name

7) Email *

Verify Email *

7) Ohio CE License # if applicable

8) Participant

First Name

Last Name

8) Email *

Verify Email *

8) Ohio CE License # if applicable

9) Participant

First Name

Last Name

9) Email *

Verify Email *

9) Ohio CE License # if applicable

10) Participant

First Name

Last Name

10) Email *

Verify Email *

10) Ohio CE License # if applicable

Would you like to sign up to receive communications from VAP and SVAA? *

Yes

No

Almost done!

After you enter your payment information....

You will receive an email confirmation of your purchase.
Our education department will create individual accounts in our Learning Management System (LMS) using the participant's name and email address(s) provided.
- Each class participant will receive an email with login instructions one week prior to the start of the class.
- All class participants, both in person, and virtual, will be required to use the LMS to complete course activities or assignments.
If you have any questions, or need to make changes to your registration, please contact Dana at DZedak@victimassistanceprogram.org