PEP - Enroll Now - Lakeland Care

Name(Required)

First Last

Organization(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Number of Attendees(Required)

Tier Chosen(Required)

Click HERE for pricing structure.

Session Dates for Tier 1(Required)

Session Dates for Tier 2(Required)

Session Dates for Tier 3(Required)

Coaching sessions scheduled upon completion of enrollment.

Do you require any accommodations (ie. accessibility, auditory, dietary, etc.)?

Tax Exempt Certificate

If you are a tax-exempt organization, please upload your tax-exempt form here. If no form is uploaded, sales tax will be charged when applicable.

Max. file size: 50 MB.

Is your organization a LCI Contracted Provider?(Required)

Yes

Is your organization a non-profit organization?(Required)

Yes

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PEP – Enroll Now