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 Date February 1,2008 - Tulsa March 7,2008 - Norman April 4,2008-Tulsa May 2,2008 - Norman June 6,2008 - Tulsa August 1,2008 - Norman September 5,2008 - Tulsa November 7,2008 - Norman December 5,2008 - Tulsa

Method of Payment:

Check(personal)
Check(Company)  
Money Order  
Pay at the Door(cash,check,moneyorder)  
Purchase Order** --Due to the amount of problems associated with purchase orders, I can no longer accept them without restriction. The only way Purchase Orders will be accepted is if payment is received prior to the date of the training.

 I have read and agree to these terms regarding P/O's

Select a Payment Amount and Class Type:

$50.00 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
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