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SEPM - Lakewood CO

Registration Form


Instructions: You may register for this class in one of 3 ways:

  1. Call our office at 202-802-0534 and provide credit card information--no forms necessary.
  2. Complete the registration below and email to
  3. Complete an agency SF-182, DD-1556, or other agency training form and email to

    NOTE: If emailing, do not include credit card info - please call the office to provide the number

Confirmation emails will be sent to the participant. Credit cards usually charged following the class unless requested to be charged earlier. Invoicing will be done in accordance to payment type indicated on the form below or the agency training form.

Date: Aug 13-15
Student Name:
Agency Name:
Mailing Address:
City, State and Zip:
Office Phone:
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: $895.00
Select Payment Type
If paying by Credit Card,
Credit Card Number
Expiration Date:
3 Digit v-code:
Card holder's billing zip code:
Name on Credit Card:
Email Address of Card Holder :
Phone Number of Card Holder :
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.

Rushford & Associates
303-989-3796 (voice) ~ 303-985-4996 (fax)
Email Us
615 South Xenon Court ~ Lakewood, CO 80228

Copyright 1999 - 2019 Rushford & Associates