| Personal Information |
| Name: |
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| Nickname: |
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| Email Address: |
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| Home Phone: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Current Employer |
| Business Name: |
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| Business Phone: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Current position: |
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| How long have you held this position?: |
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| Year(s) of management or supervisory experience: |
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| Duties of present position: |
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| How many employees do you supervise? |
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| Education |
Highest
educational level attained:
12 College:
1
2
3
4
Graduate:
1
2
3
more |
| Undergraduate major: |
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| Graduate field: |
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| Seminar date you are enrolling for: |
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| What are your major
objectives in enrolling in this seminar? |
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| Referred by: |
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| Payment |
Payment information: You may pay by check or credit card. Please choose the appropriate option and follow the accompanying instructions.
Credit Card
Bill me personally
Bill my company |
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The fee for the 3-Day, LTPS is $1295 and includes all seminar
materials, continental breakfast, lunch and refreshments at breaks.
Allow 8:00 a.m. to 6:00 p.m. daily. All St. Ambrose LTPS instructors
are certified. If you register before May 22, 2009, receive the
training at a discount price of $1095. Any registrations received
after May 22, 2009, will pay the full price of $1295. Please note a
non-refundable cancellation fee of $175 will apply if you cancel
anytime between June 10 and June 23, 2009. |
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Credit card: If paying by credit card, please submit this form and call Kim Raap with your credit card information. You may reach her at 563/441-9950 or toll-free at 800/747-7574.
Bill me/Bill company: A bill will be sent either to your home address or your company's address provided above. Please call Kim Raap with any questions. |
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