Women Palante Registration Form for the Mompreneur Program

Thank you for your interest in Women Palante’s Mompreneur Program!

This form will help us get to know you better and understand your goals.

Please complete all fields and submit the form along with the payment of the $260 tuition fee.

Personal info

First name:

Last name:

Age:

Country:

Address:

City:

Estate/province:

Zip code:

Which program are you interested in registering for:

Email:

Phone Number:

Country of Origin:

Marital Status:

Do you have children?

Yes

If yes, what are their ages?

Do you speak English?

Which shift works best for you?

Time Commitment

Do you need childcare support?

Yes

Are you ready to commit to a 15-week program, with approximately 7 hours each week, including in-person meetings?

Yes

Annual Household Income:

How did you hear about the Mompreneur Program?

Fee

Registration Fee:

Total Tuition Fee: $260 USD You can make the full payment now or make an initial deposit of $87 USD.

Credit Card info

First name:

Last name:

Company:

Address:

City:

Estate/province:

Zip code:

Country:

Card number:

Expiration date:

CVV:

Registration: Mompreneurs

Women Palante Registration Form for the Mompreneur Program

Personal info

Time Commitment

Fee

Credit Card info