Please fill out a separate form for each student and return by e-mail (jstiglich@aol.com),
by fax (1-858-538-5372) or by ground mail (12316 Dormouse Rd, San Diego, CA 92129 USA).
Seating is limited, so register early.
Name/Title: _________________________________________________
Organization: _________________________________________________
Address: _________________________________________________
_________________________________________________
_________________________________________________
Office Phone: _________________________________________________
Mobile Phone: _________________________________________________
E-mail: _________________________________________________
-----------------------------------------------------------------------------
TRAINING FEE:
$1400.00 if payment is received at least one month prior to the training start date.
$1500.00 if payment is received at least one week prior to the training start date.
$1600.00 if payment is received less than one week before the training start date.
___ Payment enclosed.
___ Check. Make checks payable to DM Consulting.
___ Credit card. Visa MasterCard AMEX (circle one)
Card holder name _______________________________________________________
Card number _______________________________________________________
Expiration date _______________________________________________________
___ Payment will be made at a later date, prior to the start of the training.
___ Bill my organization/me. The reference/purchase order number and invoice address is:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Confirmation of registration will be sent to all attendees.
All payments are 100% refundable if you cannot attend the training.