MASTERY WORKSHOP REGISTRATION FORM

Thank you for registering for the Mastery Workshop.

Full Name: *

Main Address:

Street Address

Address continued

City *

State *

Zip

Company Name: *

E-mail Address: *

Work Phone #: *

Cell Phone #: *

Mastery Workshop Course Dates: (please select one) *

Referred By:

Payment Options: *

Payment Option Notes:

To secure your place in a workshop, you may pay in full, pay a $100 non-refundable deposit, or invoice your employer (if you have been given permission to do so). If you make a deposit, the outstanding amount will be due on the first day of the workshop. (Cancellations - $100 non-refundable deposit can be transferred to another workshop within one year)

How to Pay:

For Credit Card Payments: Please call Melissa at 619-450-6777 x229 to charge your card. Check and Money Orders: Please send to ChoiceWorks Inc. 715 J Street, Suite 301 San Diego CA 92101

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