Rushford and Associates...Registration Form

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The Role of the Special Emphasis Program Manager - Arlington VA

Registration Form

$895.00

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:	Sep 18-20, 2012
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:	$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