First Name: Last Name

Partner's Name:

Address:

City/Town:

State: Zip Code:

Telephone Number: Email Address:

Please check the two-day workshop that you are registering for:

September 28 & 29, 2013

November 16 & 17, 2013

Please select your payment method

Check

Name on Card:

Credit Card #: Expiration Date:

Cancellation Policy:

If the event is canceled by the presenter you will receive a full refund.  If you cancel your registration eight or more days prior to the start of the seminar, the registration fee less a $150.00 administration fee will be returned. If you cancel seven days or less, no refund will be issued.