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Instructor Development Workshop Registration
October 28 & 29, 2013

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Course: Full Course - Both the 28th & the 29th ($95)
Just Monday the 28th ($70)
Just Tuesday the 29th ($70)
NO REFUNDS WILL BE GIVEN FOR CANCELLATIONS.
First Name:
Last Name:
E-Mail Address:
Phone Number: () -  EXT
License Number(s):
(If you have multiple licenses, you
may receive CE credit for both.)
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Credit Card #:
(Visa, MC, or AmEx)
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