| *Type of Organization: |
*Registration Source |
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Company
Name: |
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Street
Address: |
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P.O. Box:
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City:
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State:
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Zip: |
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Phone
Number: |
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Email: |
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Fax Number:
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Approving
Manager's Name: |
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| First
Attendee Information: |
| First Name: |
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Title: |
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| Last Name: |
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Date: |
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| Nickname: |
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First Time Attendee? |
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| Second
Attendee Information: |
| First Name: |
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Title: |
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| Last Name: |
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Date: |
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| Nickname: |
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First Time Attendee? |
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| Third
Attendee Information: |
| First Name: |
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Title: |
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| Last Name: |
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Date: |
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| Nickname: |
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First Time Attendee? |
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| Fourth
Attendee Information: |
| First Name: |
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Title: |
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| Last Name: |
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Date: |
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| Nickname: |
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First Time Attendee? |
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| Fifth
Attendee Information: |
| First Name: |
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Title: |
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| Last Name: |
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Date: |
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| Nickname: |
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First Time Attendee? |
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| Tuition: |
$595 early registration
(Registrations received more than 15 days prior to date
of seminar) |
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$645 standard registration |
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Group Discount: Deduct
$25 per attendee when three or more from the same organization
attend the same seminar. |
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After you submit your information,
we will call you regarding the method of payment. |
| Comments: |
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By submitting this form,
you agree to all terms as listed above. |
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