Registration Form
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First Name:
Last Name:
Title:
Organization:
Address 1:
Address 2:
City:
State:
Zip or Postal Code:
Country:
Telephone:
Fax:
E-mail:
Please check all classes you would
like to register for.
If you cannot find the class you are
interested in, please refer to the
class schedule for an alternate
contact person.
Sept. 13, 2004
MOAB
®
Instructor Recertification
$525
Sept. 14, 2004
MOAB
®
1-Day Instructor
$795
Sept. 14-16, 2004
MOAB
®
3-Day Instructor
$1475
Dec. 6, 2004
MOAB
®
Instructor Recertification
$525
Dec. 7, 2004
MOAB
®
1-Day Instructor
$795
Dec. 7-9, 2004
MOAB
®
3-Day Instructor
$1475
Payment Method:
Select Payment Method
Mastercard
Visa
Purchase Order
Check or Money Order
MC, Visa, PO or Check#:
CC Exp Date:
Cancellation Policy:
To receive a full refund, please notify MOAB
®
Training in writing or by phone no later than five days prior to the course date. Cancellations received less than five days prior to the course will be billed a 25% cancellation fee or refunded the difference already paid. Substitutions are welcome at any time.