Workshop Registration

Step #1 - Please Fill Out the Registration Form Completely!

The requested information on this form is Not Used for Marketing Purposes!

  • We must have this information in order to send you a confirmation letter with information on the location of the hotel with directions or in case of any changes after the mailing.
  • When we receive checks and credit card payments from PayPal, we use the form information to connect your registration and payments, saving your spot in the Workshop.
  • Without the form information we can not confirm your registration or reserve your seat.
  • Cancellation Policy for all Workshops: If you decide to cancel, you must do so 21 days prior to workshop to receive a refund less a $50 administrative fee.
  • If you have any questions, please Contact Walt Ciecko, (302) 429-0195

Please Begin Your Registration by filling out the form below first:


Step #2 - Select A Payment Method

Payment Method #1: Submit Your Payment by Check to:

  1. Complete and Send Registration Form Above First if You Have Not Done So as Yet.
  2. Mail Your Payment Check to:

Walt Ciecko, Ph.D, BCB
1301 North Harrison Street Suite 101
Wilmington, DE 19806

Payment Method #2: Payment by Credit Card:

  1. Complete and send your registration form above first before you complete your payment below.
  2. Click the PayPal Image below to make your payment using a credit card.

paypalIf you selected payment by credit card then click the PayPal Image to
Make Your Payment with a Credit Card at PayPal

This completes your registration process. Thank your for your registration. I look forward to working with you at the workshop. If there are any questions or concerns feel free to call me.

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Walt Ciecko, Ph. D., BCB
1301 North Harrison Street, Suite 101
Wilmington, DE 19806
302-429-0195 Ext 1