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	Seminar Registration Form

To enroll in one of our upcoming seminars, please complete the form below. Should you have any questions regarding the registration process or on our seminars in general, please contact Virginia Daras at (514) 333-5340 or by e_Mail at vdaras@prestonphipps.com.
* Denotes required field
Name*
Company*
Address 1*
Address 2
City*
Province_State*
Country*
e_Mail*
Phone*	Ext.
Seminar*
Date*
Fax
Please let us know of any allergies:
Are you vegetarian:
Let us know if you have any questions or require special accommodations

For invoicing purposes, if you wish to use a different address, please complete this form:

Name
Company
Address 1
Address 2
City
Province_State
Country
Postal / Zip Code
Reference

How do you plan on paying for this course?

Check
Credit Card (We accept VISA or MasterCard)

Note: We do not process credit cards on-line. Once this form has been submitted, you will be contacted by phone to make payment arrangements.

Do you have a purchase order number?

Yes:
No

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