REGISTRATION
   
     

CONTACT INFORMATION:

212 Edgewood Dr.

Pineville, LA. 71360

PHONE:

(318) 443-0845

(888) 229-8128

FAX: (318) 443-0875

EMAIL:

ptr@suddenlinkmail.com
 


REGISTRATION FEES:

$140.00 Full Day Seminar or $80.00 Ethics: Half Day, On-Site Registration - $150.00

Summer Symposium Fees are: $340.00 for entire symposium and $80.00 per individual sessions.

If you attend 3 of our seminars at the full day price then you will receive a 4th seminar for free.

You can print out this form and mail it in with payment to: 212 Edgewood Dr., Pineville, LA. 71360 or you can call (318) 443-0845 or Toll Free (888) 229-8128

 

 

SEMINAR TITLE AND LOCATION:

 

NAME: PROFESSION:

 

ADDRESS:

 

CITY: STATE: ZIP CODE:

 

PHONE: E-MAIL:

 

Check if special provisions will be necessary for impairments.

 

METHOD OF PAYMENT:

 

VISA

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MASTERCARD

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DISCOVER

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