May 2009

Please specify Media - Note DVDs will only play in a computer

¨  DVD

¨  CD

Last Name

First Name & Initial

Street Address

City / Town

Postal Code

Telephone Residence

(           )

Telephone Business

(           )

Cellular

(           )

Fax

(           )

E-Mail Address

Student Signature

1) I have read and understood all the conditions regarding our refund policy (please see below).

Please initial________.

2) In order to receive an invitation to attend the residential session  I MUST submit ALL assignments.

Please initial__________.