HANDLE WITH CARE & Re/CERTIFICATION PROGRAM” – “INSTRUCTOR PROVIDENCE, RI SEMINAR - REGISTRATION FORM Please Fax completed Form to: Seminar Administrator @ 845-256-0094 NOV. 30 DEC. 02, 2016 9:00 AM 5:00 PM – – When: Training: Washington Park Community Center 42 Jillson Street Providence, RI 02905 TEL: (401) 461-6650 Lodging: Courtyard Providence Warwick 55 Jefferson Park Road Warwick, RI 02888 TEL: (401) 272-1191 No Rooms Reserved – Cost: $1250 Per Participant SPECIAL PROMOTION *** TWO FOR THE PRICE OF ONE WHEN REGISTERING FOR THE FULL PROGRAM *** Company Name: Address: City State Zip Telephone: Fax: E-Mail: Participant/ Name(s): Cell or Dir.# ______________ Cell or Dir.# ______________ Wish to reserve the following Name of Agency Days # of Cost Day 1 Verbal Training $400/person – Day 2 Basic Physical Training $400/person – Day 3 Instructor & Re/Certification $450/person – Payment should be made payable to Handle With Care Behavior Management System EIN at 184 McKinstry Road, Gardiner, NY 12525, Tel: 845-255-4031. Payment can also be made at the time of training. I hereby represent that I am authorized to submit this Registration form on behalf of my agency. By registering, my agency is obligating payment for the above-registered people. Contractual terms associated with this training are incorporated herein and can be viewed on our web site: . To receive a refund you must cancel 30 days before the scheduled training. If registered people are unable to attend due to sickness, weather or any other emergency or act of god a credit will be given for that person to attend another Handle With Care Seminar. Signature of authorized agency agent Date Print Name, Title
HANDLE WITH CARE – “INSTRUCTOR & Re/CERTIFICATION PROGRAM” PROVIDENCE, RI SEMINAR - REGISTRATION FORM Please Fax completed Form to: Seminar Administrator @ 845-256-0094 When: NOV. 30 – DEC. 02, 2016 9:00 AM – 5:00 PM Training: Lodging: Washington Park Community Center 42 Jillson Street Providence, RI 02905 TEL: (401) 461-6650 Courtyard Providence Warwick 55 Jefferson Park Road Warwick, RI 02888 TEL: (401) 272-1191 – No Rooms Reserved Cost: $1250 Per Participant SPECIAL PROMOTION *** TWO FOR THE PRICE OF ONE WHEN REGISTERING FOR THE FULL PROGRAM *** Company Name: Address: City State Zip Telephone: Fax: E-Mail: Participant/ Name(s): Cell or Dir.# ______________ Cell or Dir.# ______________ Wish to reserve the following Name of Agency Days # of Cost Day 1 – Verbal Training $400/person Day 2 – Basic Physical Training $400/person Day 3 – Instructor & Re/Certification $450/person Payment should be made payable to Handle With Care Behavior Management System EIN at 184 McKinstry Road, Gardiner, NY 12525, Tel: 845-255-4031. Payment can also be made at the time of training. I hereby represent that I am authorized to submit this Registration form on behalf of my agency. By registering, my agency is obligating payment for the above-registered people. Contractual terms associated with this training are incorporated herein and can be viewed on our web site: . To receive a refund you must cancel 30 days before the scheduled training. If registered people are unable to attend due to sickness, weather or any other emergency or act of god a credit will be given for that person to attend another Handle With Care Seminar. Signature of authorized agency agent Date Print Name, Title
11.30-12.02.16.PROV.RI.%20semareg.docx