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.


    Walt Ciecko, Ph. D., BCB
    605 Wynyard Rd
    Wilmington, DE 19803