Registration - Intro Workshop

Participant Name *

First Name Last Name

Preferred Name

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

E-mail *

Date *

May 4th June 8th

What brings you to explore NLP Marin? *

How did you hear about us? *

If someone referred you to this course, please provide their name so we can thank them!

Payment Option

Introduction to NLP $ 27.00

Payment Method

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Agreement *

I am agreeing to pay the entire tuition amount.

Refund Policy *

I agree to NLP Marin's refund policy that I will only receive a refund if requested at least 14 days before the workshop begins. If I am unable to attend, I can retain a credit for use within 1 year of payment.

Student Signature *

Date *

/ Month / Day Year

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