Primary Contact Name *

First Name

Last Name

Address *

Address 1

Address 2

City

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Accounts Payable Contact Name *

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Are you a tax-exempt provider, organization or facility? *

Please enter your tax exempt ID number in the field below or send proof of tax exemption status to cope.dyork@gmail.com and reference this order.

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Hard-copy Student Manuals *

Please indicate which hard-copy student manuals (three per attendee) you would like to have included in your order. All hard-copy manuals will be sent to the address listed above.

COPE Child Manuals

COPE Teen Manuals

COPE 15-Session Teen Manuals (for 15-session Instructors only)