2019 Online Cognitive Camp RegistrationThe Cognitive Emporium's online Cognitive Camp is for students entering Grades 3-12. The camp is four weeks long and two training sessions are offered:Session 1Starts: Monday, June 3, 2019Ends: Friday, June 28, 2019Session 2Starts: Monday, July 8, 2019Ends: Friday, August 2, 2019 The sessions run daily, Monday to Friday, from 11:30 AM to 12:30 PM Central Time. Note: Space is limited and registration will close without notice once spots are filled. You will be taken to an intake questionnaire when you submit your registration form. The questionnaire is the starting point to help us design your child's program. Please ensure you complete and submit the questionnaire before closing your browser.Parent's Name* First Last Parent's Email Address:* Parent's Phone Number*Child's Name* First Last Session Selection: Please select one of the two sessions.Session 1: June 3, 2019 to June 28, 2019Session 2: July 8, 2019 to August 2, 2019Both sessions run daily, Monday to Friday, from 11:30 AM to 12:30 PM Central TimeSession 1: June 3, 2019 to June 28, 2019 Price: $639.00 $799.00 - 20% ($160.00) = $639.00Session 2: July 8, 2019 to August 2, 2019 Price: $639.00 $799.00 - 20% ($160.00) = $639.00Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Security Code Cardholder Name Billing Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your credit card will be charged and registration will be taken when you submit the form.Once you submit your registration, you will be taken to a thank you page with an intake questionnaire. This will be our starting point in designing the most effective program for your child.Please ensure you complete and send the form before closing your browser. This iframe contains the logic required to handle Ajax powered Gravity Forms.