ADVANCED STUDIES - APRIL 2010 - ENROLLMENT FORM
PHONE: 800-457-0237 or 760-643-1760 FAX: 760-643-1761
PO Box 2317 • Vista. CA  92085

Please fill in the information below, submit it, and someone will contact you regarding your registration.

Salutation:
Name:
Title:
Company:
Mailing Address:  
City:    State:    Zip:  
Phone: ( )
Fax: ( )
E-mail:
* Required field
Website:

(A) $585 Advanced Studies Seminar - Two-Day Seminar
(B) $525 Advanced Studies Seminar - Special Rate for Special District Institute Certificate Holders
(C) $100 Spouse/Guest Meal Package for Seminar
  Guest Name:

 

  • $25.00 Early registration discount for Options A and B Only (must receive payment by 4/1/2010)
Sub Total of Registration $
Subtract $25.00 Early Registration
(Payment by 4/1/2010 ONLY)		 $ (if applicable)
Total Registration Fee $
Special Needs:
Wheelchair Access
Visually Impaired
Hearing Impaired
Vegetarian Meals
Other

METHOD OF PAYMENT: Payable to Special District Institute

Check Credit Card Invoice - PO#:

If you are planning on paying by credit card, please fax your credit card information to 760-643-1761 or e-mail it to trishansell@aol.com.


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