Change pro | Experiential

Your name *

First

Last

This is the name of the person actual placing the request

Your email *

This is the email of the individual filling in this request

Program / Licence information

I am ordering *

Type of licence you are requesting *

Online version
Downloadable version

Online version (max 12 teams, only available in English)

What is the date of your Change pro workshop? *

What is the name of the organisation that will be receiving the program? *

What is the title of the program or event? *

Which below best describe your academic program type? *

How many students/participants will be attending the program/event ? *

How many teams will you be setting up? *

Please note that this can only be a maximum of 12 teams. Please note that when online version is required, there is an additional costs per team: of 20€/USD on top of the costs of the daily license.

What is the name of your certified change pro facilitator? *

First

Last

Which language version do you require? *

Billing information

Name of the contact person for billing purposes? *

First

Last

What is the name of the organisation to be billed? *

Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

P.O. Number or reference:

Will you be paying by credit card?

Comment or Message

Change Pro licence request

Program / Licence information

Billing information