Participant Registration

Part I                                                                                                                Sponsored by:

Course Location:     Columbus                                       Date of Course  February 2010

Part II

Name:                                                                              E-Mail Address:

Business Name:                                                                                          Business Phone: 

Business Address                                                                                       Cell Phone #:        

City:                                                                         State:                          Zip Code:

Part III

Investment Options:  (1st payment will be charged 14 days prior to class start date, and next payment will be due the LD of the month in which the class begins, with remaining payments being taken out monthly on the LD of the month.)

_______ Option 1  ($1199) - Check, VISA, MasterCard, Amex, Discover)

_______ Option 2  ($250 deposit, 3 payments of $326, for total of $1228. Credit card only) 

_______ Option 3 (Columbus Chamber discount $1099. Memberships verified )

_______ Option 5 Non-profit rate ($849) 

Credit Card Information: (Circle one)  -    VISA       MasterCard       AMEX       Discover

Card Number:                                                                 Exp. Date:                             CID #:

Signature:

A $20 administrative fee will be charged for NSF checks and each time a credit card is declined.,

All fees charged by the institution will be added to the student's financial responsibility.

Fax form to (360) 343-1897 or send to P.O. Box 14098, Columbus, OH 43214-4908.  CANCELLATION POLICY:  Cancellations received less than 14 days prior to the course start date will incur a $100 processing fee.