Registration

If you are paying by check, you may use the form below to submit your registration information, and send your check separately by mail to the address provided at the bottom of the form.

If you plan to pay by credit or debit card online, please fill in the additional credit card payment fields below, and submit. You may enter your personal information with confidence, as we use SSL encrypted security for our registration form and shopping cart.

Your registration details * Indicates a required field

Your First Name *

Your Last Name *

Email *

Address *

City *

State *

Zip *

Telephone *

Birth year *

Is this your first time?
YesNo

How did you hear about Crones Counsel?

Describe your special needs if any:

Will you have a roommate?
YesNo

Name of your preferred roommate

Your emergency contact's name *

Your emergency contact's phone number *

Preferred Payment Method:
CheckCreditDebit

I have read and accepted the Liability Waiver * (opens in new window)

 

 

Checks payable to: CRONES COUNSEL, INC.

Mail checks to:
Crones Counsel
c/o Kay Marie Bouma
5452 Hillery Drive
Scottsdale, AZ 85254

Phone: 740-625-7278
Email: registrar@cronescounsel.org

Refunds: Cancellations up to August 1, 2019 will be given a full refund. After August 1, 2019 there will be a $25.00 cancellation fee.