Workshop Registration
Please fill out this form to register for your upcoming workshop
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WORKSHOP SELECTION
Session Dates:
*
Please Select
June: 8th, 15th, 22n
July: 6th, 13th
August: 3rd, 10th
September: 6th, 7th
September: 13th, 20th
September: 14th, 21st
October: 5th, 12th
October: 19th, 26th
November: 2nd, 9th
November: 23rd, 30th
How Many Will Be Attending from Your Company?
*
Individual (1) - $1,500
Co-worker (2) - $1,750
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COMPANY DETAILS
Company
*
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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ATTENDEE DETAILS
Name
*
First Name
Last Name
E-mail
*
Attendee #2
*
First Name
Last Name
E-mail
*
Attendee #3
*
First Name
Last Name
E-mail
*
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PAYMENT
Calculation
Total:
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USD
Description
Credit Card Details
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Last Name
Credit Card Number
Security Code
Card Expiration
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