To register, complete the following form and return with your payment
SASSI Training Workshop Enrollment Form
Name:
Occupation:
Agency:
Mailing Address:
City: State: ZIP:
Phone Number:
Confirm Phone Number:
Email Address:
Confirm Email Address:
WorkShop Date: Select One February 3, 2012 - Tulsa March 2, 2012 - Norman July 6, 2012 - Tulsa August 10, 2012 - Norman November 2, 2012 - Tulsa December 14, 2012 - Norman
Method of Payment:
Check(personal) Check(Company) Money Order Pay at the Door(cash,check,moneyorder)
Select a Payment Amount and Class Type:
$60.00 for the one individual level (Half Day) $100.00 For both Levels I and II (Full Day)
Please make Checks or Money Orders payable to Terry L. Stover and return to:
Terry L. Stover 4706 S. 199th E. Ave. Broken Arrow, OK 74014 Cell Number: (918) 857-1955 (local in Tulsa )Fax: (918) 355-5703
All cancellations must be made via phone or e-mail 48 hours before the training for a refund.
I have read the above and agree to all terms herein
