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:  _________________________________________________
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TRAINING FEE:
   $1200.00 if payment is received at least one month prior to the training start date.
   $1350.00 if payment is received at least one week prior to the training start date.
   $1500.00 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.