Instructions: We do not accept on-line registrations, so please complete this form, print it, and fax to 303-985-4996 or mail completed forms to Rushford & Associates, 615 So. Xenon Court, Lakewood, CO 80228.
OR Fax or mail your organization's purchase order or training form to above number/address |
| Date: |
April 27-28 2010
|
| Student Name: | |
| Agency Name: | |
| Mailing Address: | |
| City, State and Zip: | |
| Office Phone: | |
| Fax: | |
| Email Address: | |
Name of person completing form:
(If different than student) | |
Phone number of person completing form:
(If different than student) | |
Email Address of person completing form:
(If different than student) | |
| Cost: | $545.00 |
| Select Payment Type |
|
If paying by Credit Card,
Credit Card Number | |
| Expiration Date: | |
| 3 Digit v-code: |
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| Card holder's billing zip code: |
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| Name on Credit Card: | |
| Email Address of Card Holder : |
|
| Phone Number of Card Holder : |
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| Signature: | ____________________________________ |
Cancellation policy:
Nominations cancelled 30 days prior to class date, no charge.
Cancellations from 30 to 15 days prior to class, 50% fee charged.
Cancellations 14 days or less, full fee charged.
Registration deadline: Two weeks prior to the start of class
Space is Limited. Please Register Early
Questions: Call 303-989-3796 or email now.
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