Spectrum Temperament Development Inc.

Certification Training Registration Form

Tulsa, Oklahoma

Please reserve my space for (please check one of the following choices below):

� Stress Management Module*

Cost: $300   

April 30th - May 1st, 2012

9:00 am to 5:00 pm

*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_______________________________

Copy write 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 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 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.  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.