Heart Transplant Surgery Registration Parent* First Last Email* Enter Email Confirm Email Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Phone*Zoom Username*Type your Zoom username below. This is the one username you'll use during the event. If there's only one or two students, you can set your username as their first names (Jack and Jill, for example).If there are several students, I recommend a username that represents your family. (Smith Family, for example). It makes it easier for the teacher/facilitator to interact with your students.IMPORTANT!Make sure you type the correct username you'll be using. If you use a different one, you won't be able to enter the event (no refunds). I'll email a PDF that explains how to verify and change your username before the event.Students (or homeschool graduates, or lifelong learners)*List names and ages (not grade level) of all students participating. (If you're a homeschool graduate or adult lifelong learner, note that in this section. ) Your registration will be deleted and you'll be asked to resubmit if this information isn't included. I apologize in advance, but it's required.Please check the box in the section below to confirm you've read, understand, and agree with each item. (The checkbox may be a tiny box in the middle of the column, depending on your device.)* 1. This program will be delivered via Zoom. The username you submit with this registration is the one you must use for the event. 2. Only one login per family is allowed. Students/parents won't be able to view the event from individual devices or in multiple locations.3. Only registered students and their parents can attend. You must have your camera on during the entire event so we can monitor attendance. Registrants without a camera will be dropped from the event (no refunds). 4. No refunds for any reason. Spots are not transferable. Heart Transplant Surgery* Price: $20.00 Credit Card*Payment is due upon submission. Your payment will be voided/returned if your registration is not accepted. Card Details Cardholder Name Submit Registration & Payment*I've read, understand, and agree with the requirements of this event and the no-refund policy.CommentsThis field is for validation purposes and should be left unchanged.