Refund Request Form
Name
*
First Name
Last Name
Email
*
Phone Number
*
-
Area Code
Phone Number
Date of Request
*
-
Month
-
Day
Year
Date
I am requesting a refund for:
*
quarterly workshop or event
workshop/s associated with a conference
Reason:
*
Family, work, or other conflict (for non-conference workshops only)
Illness or debilitating health condition for yourself or an immediate family member.
Additional details or extenuating circumstances:
Submit
Should be Empty: