Spectrum Temperament Development Inc.

2010 Certification Training Registration Form

Please reserve my space for:

*Please Note:  Module Prerequisite – Foundation Training completion

Fee covers training and training materials.  Meals, lodging and travel not included.  Please complete the following information.  If more than one person is attending, please complete a separate registration form.

Name: ____________________________________________ Title: ___________________________________

Organization: _______________________________________________________________________________

Address: __________________________________________________________________________________

City: _____________________________________ State: ____________________ Zip: ___________________

Phone: ____________________ Fax: _______________________ E-mail_______________________________

Copyright date on your facilitators guide _______________________________________________________________________________

Reserve your space at least 15 days prior to the training date by returning this registration form with a check, purchase order number, or credit card information.  Confirmation will follow upon receipt of a completed registration form.

Spectrum Temperament Development, Inc.

P.O. Box 700237

Tulsa, OK   74170-0237

(918) 747-7373 or (800) 354-1574 

Fax (918) 747-0197

I have enclosed:

� Business or Personal Check

�  Bill my Purchase Order # ________________________

Charge this registration to Visa, MasterCard, Discover or AX # _________________________________________________

Expiration Date: __________________       Signature:   ______________________________________________

Please answer the following questions.  If you need more room, please use the back of this form:

What are your goals for the training?______________________________________________________________

________________________________________________________________

________________________________________________________________

Who will be your audience when conducting Spectrum Development workshops?____________________________

_______________________________________________________________

_______________________________________________________________

Registration/Cancellation Policy:  Registration must be received 15 working days prior to the training date.  Cancellation will be accepted, subject to a 50% service charge per person, up to 5 working days before the training. The entire registration fee is due if the cancellation is made within 5 days of the training. Any cancellation service charged retained may be applied to any future training or products.   Substitutions of participants may be made at any time.  In the event of a cancellation by Spectrum Temperament Development, Inc., liability is limited to the return of the registration fee only.