{"id":43,"date":"2019-08-26T20:43:44","date_gmt":"2019-08-26T20:43:44","guid":{"rendered":"https:\/\/rachellebloughltd.com\/blog\/?page_id=43"},"modified":"2025-03-29T01:58:37","modified_gmt":"2025-03-29T01:58:37","slug":"register","status":"publish","type":"page","link":"https:\/\/rachellebloughltd.com\/blog\/register\/","title":{"rendered":"Register for Alzheimer&#8217;s Disease and Dementia Care Seminar"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">THREE OPTIONS FOR REGISTRATION AND PAYMENT&#8230;.<\/h4>\n\n\n\n<p>1.  Pre-register and submit payment by check, <a href=\"https:\/\/rachellebloughltd.com\/blog\/seminar-pre-registration-form\/\">please click here for the pre-registration form.<\/a><\/p>\n\n\n\n<p>2.<a href=\"https:\/\/rachellebloughltd.com\/blog\/wp-content\/uploads\/2019\/10\/registration-form.pdf\"> Print out a registration form and mail in payment<\/a><\/p>\n\n\n\n<p>3. <strong>Register and submit payment by PayPal or Credit Card use the form below.<\/strong><\/p>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-56 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-56\" data-uid=\"69dfc0cb44e91\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-56\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-56 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"56\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69dfc0cb44e91\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12  register\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69dfc0cb44e91-label\" aria-describedby=\"forminator-radiogroup-radio-2-69dfc0cb44e91-description\"><span id=\"forminator-radiogroup-radio-2-69dfc0cb44e91-label\" class=\"forminator-label\">Select a Seminar<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69dfc0cb44e91\" class=\"forminator-radio\" title=\"May 2, 2026 -  Alzheimer\u2019s Disease and Dementia Care Seminar - Online\"><input type=\"radio\" name=\"radio-2\" value=\"January-17,-2023-Alzheimer\u2019s-Disease-and-Dementia-Care-Seminar-\u2013-brochure\" id=\"forminator-field-radio-2-1-69dfc0cb44e91\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-69dfc0cb44e91-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">May 2, 2026 -  Alzheimer\u2019s Disease and Dementia Care Seminar - Online<\/span><\/label><span id=\"forminator-radiogroup-radio-2-69dfc0cb44e91-description\" class=\"forminator-description\">Seminars by Rachelle Blough<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p>BROCHURE<br>May 2, 2026, 8:30a - 5:0p Central Time, Alzheimer's Disease and Dementia Care Seminar - Online via Zoom - <a href=\"https:\/\/rachellebloughltd.com\/blog\/seminars\/may2nd-alzseminar-CDP-blough-instructor.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">brochure<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69dfc0cb44e91\" id=\"forminator-field-name-1_69dfc0cb44e91-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_69dfc0cb44e91\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69dfc0cb44e91\" id=\"forminator-field-email-1_69dfc0cb44e91-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_69dfc0cb44e91\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69dfc0cb44e91\" id=\"forminator-field-phone-1_69dfc0cb44e91-label\" class=\"forminator-label\">Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-1_69dfc0cb44e91\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69dfc0cb44e91-label\"><span id=\"forminator-radiogroup-radio-1-69dfc0cb44e91-label\" class=\"forminator-label\">Do you want CEUs?<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69dfc0cb44e91\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-1\" value=\"yes\" id=\"forminator-field-radio-1-1-69dfc0cb44e91\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69dfc0cb44e91\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-1\" value=\"no\" id=\"forminator-field-radio-1-2-69dfc0cb44e91\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69dfc0cb44e91\" id=\"forminator-field-address-1-street_address_69dfc0cb44e91-label\" class=\"forminator-label\">Street Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-1-street_address_69dfc0cb44e91\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_69dfc0cb44e91\" id=\"forminator-field-address-1-address_line_69dfc0cb44e91-label\" class=\"forminator-label\">Apartment, suite, etc<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_69dfc0cb44e91\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69dfc0cb44e91\" id=\"forminator-field-address-1-city_69dfc0cb44e91-label\" class=\"forminator-label\">City <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"E.g. Chicago\" id=\"forminator-field-address-1-city_69dfc0cb44e91\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_69dfc0cb44e91\" id=\"forminator-field-address-1-state_69dfc0cb44e91-label\" class=\"forminator-label\">State\/Province <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"E.g. Illinois\" id=\"forminator-field-address-1-state_69dfc0cb44e91\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69dfc0cb44e91\" id=\"forminator-field-address-1-zip_69dfc0cb44e91-label\" class=\"forminator-label\">ZIP \/ Postal Code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"E.g. 60657\" id=\"forminator-field-address-1-zip_69dfc0cb44e91\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69dfc0cb44e91\" id=\"forminator-field-textarea-1_69dfc0cb44e91-label\" class=\"forminator-label\">Who Referred You?<\/label><textarea name=\"textarea-1\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-textarea-1_69dfc0cb44e91\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row forminator-hidden\"><div id=\"paypal-1\" class=\"forminator-field-paypal  forminator-col-12 \"><input type=\"hidden\" name=\"paypal-1\" id=\"forminator-paypal-1-field_69dfc0cb44e91\" class=\"forminator-paypal-input\" data-is-payment=\"true\" data-payment-type=\"paypal\" data-currency=\"usd\" data-amount-type=\"fixed\" data-amount=\"185.00\" data-label=\"\" data-locale=\"en\" value=\"\" \/><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69dfc0cb44e91\" id=\"forminator-field-textarea-2_69dfc0cb44e91-label\" class=\"forminator-label\">Refering individual&#039;s email address:<\/label><textarea name=\"textarea-2\" placeholder=\"E.g. text placeholder\" id=\"forminator-field-textarea-2_69dfc0cb44e91\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12 \"><div class=\"forminator-captcha-left forminator-g-recaptcha\" data-theme=\"light\"  data-sitekey=\"6Ldi4FsqAAAAANUeKRge5QUm14zhkMk1kDlO7TKO\" data-size=\"normal\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" name=\"payment_gateway_total\" value=\"\" \/><div class=\"forminator-row forminator-paypal-row\"><div class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><div id=\"paypal-button-container-56_69dfc0cb44e91\" class=\"paypal-1-payment forminator-button-paypal\"><\/div><\/div><\/div><\/div><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Send Message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"a671602747\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/blog\/wp-json\/wp\/v2\/pages\/43\" \/><input type=\"hidden\" name=\"form_id\" value=\"56\"><input type=\"hidden\" name=\"page_id\" value=\"43\"><input type=\"hidden\" name=\"form_type\" value=\"\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/rachellebloughltd.com\/blog\/register\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_10\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_10\" type=\"text\" name=\"input_10\" value=\"\" autocomplete=\"off\"><\/label><\/form><\/div>\n\n\n\n<p class=\"has-very-light-gray-color has-text-color\">d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>THREE OPTIONS FOR REGISTRATION AND PAYMENT&#8230;. 1. Pre-register and submit payment by check, please click here for the pre-registration form. 2. Print out a registration form and mail in payment 3. Register and submit payment by PayPal or Credit Card use the form below. d<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-43","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/pages\/43","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/comments?post=43"}],"version-history":[{"count":15,"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/pages\/43\/revisions"}],"predecessor-version":[{"id":519,"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/pages\/43\/revisions\/519"}],"wp:attachment":[{"href":"https:\/\/rachellebloughltd.com\/blog\/wp-json\/wp\/v2\/media?parent=43"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}