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You will receive a confirmation email upon submission of this form, along with login directions and how to complete your public profile (Local Supporter).

Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

First Name: *

Given name/prenom/vor name/nombre

Last Name: *

Family name/nom de famille/name/apelido (surname). This is the name the system will use to "find" you. If you use only one name, please put a period in the first name and put your one name in the last name box.

Private Postal Address: *

Please enter the complete postal address we would use to send a package to you from outside your country, including your country's name. Please use commas for line breaks.

Private Postal Code:

Private Primary Phone Type: *

Phone type/location #1

Private Primary Phone: *

Your primary contact telephone number or Skype ID. This will not show on the public website. Please put the number someone inside your country would dial to call you first--national number-- followed by the number someone would dial from outside your country, in parentheses, beginning with "+" followed by your country code. For example: "01865.555555 (+44.1865.555555)" (USA/Canada: "areaCode.prefix.4numbers (+1.areaCode.prefix.4numbers)")

Private Secondary Phone Type:

Secondary phone type/location

Private Secondary Phone:

Your secondary contact telephone number or Skype ID. This will not show on the public website. Please use the same formatting as for the primary phone: national number (international number)

permission: *

yes

Are you willing to be listed on the cnvc public website (www.cnvc.org)? If so, please select "yes" button and set up your public website information below(Fields starting with Public). If you select "No", any information you enter in the fields below will be deleted.
People who are normally listed on the CNVC public website are CNVC certified trainers, local nvc supporters, local nvc groups, local nvc websites, organizers, the executive director of CNVC, the director of educational services at CNVC, the CNVC international project coordinator, CNVC board members.

Public Job Title:

Staff members can enter their job title, which will show on the staff page, to help people determine who they want to contact.

Public Primary Phone Type:

Primary phone type/location

Public Primary Phone:

Your primary public contact telephone number or Skype ID. This will show on the public website. Please put the number someone inside your country would dial to call you (national number) first, followed by the number someone would dial from outside your country, in parentheses, beginning with "+" followed by your country code. For example: "01865.555555 (+44.1865.555555)" (USA/Canada: "areaCode.prefix.4numbers (+1.areaCode.prefix.4numbers)")

Public Secondary Phone Type:

Secondary phone type/location

Public Secondary Phone:

Your secondary public contact telephone number or Skype ID. This will show on the public website. Please use the same formatting as for the primary phone: national number (international number)

Public Website Title:

If you have an NVC-related website you want to list, please enter the name and URL here.

Public Website URL:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Copy the characters (respecting upper/lower case) from the image.

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