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Bill To:

*Name:

Member ID:

(if known)

*E-Mail:

Job Type:

Job Title:

Department:

Organization:

*Address:

*City:

*State/Province:

*Postal Code:

*Country:

*Phone:

Fax:

*Payment Details
* If your organization requires a PO for registration, please call us toll-free at 800-678-5376

Credit Card Number :

Expiration Month :

(MM)*

Year :

(YY)*

Card Type :

Card Holder Name :
(as it appears on the card)

All fees payable in US$

Fees:
* 1-5 faculty $95/ea. * 6-10 $495 for the group (just $50 a person when you send ten)
Enter the names and email addresses of those attending the seminar:
Name	email address	Job Type	Telephone#
1.
(if different from above)
2.
3.
4.
5.
6.
7.
8.
9.
10.

You will be brought to another screen to confirm your registration [ Cancellation Policy ]

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Available M-F 8-5 CT

Available M-F 8-5 CT

Affordable Costs

$95/ea.

1-5 people

$495

6-10 people

from the same organization