Name Title Organization Address City / State / Zip Telephone Email TRAINING FEES SAVE $200 if you enroll by June 1, 2015 YOU ARE A: Fee YOUR GENERATION: Gen X For profit-professional $2,600 Traditionalist Millennial Non-profit professional $2,100 Baby Boomer Freelance Professional $1,600 Check here if you would like to have cocktails/dinner on October 8 with other participants Cancellation Policy: If received by September 1, 2015 or earlier: full refund. September 1-17: 50% refund. After September 18, no refund, but payment can be applied to future training. FORM SUBMISSION DETAILS Please email completed form, short bio, and headshot to barbara@2164.net
Name Title Organization Address City / State / Zip Telephone Email TRAINING FEES SAVE $200 if you enroll by June 1, 2015 YOU ARE A: For profit-professional Non-profit professional Freelance Professional Fee $2,600 $2,100 $1,600 YOUR GENERATION: Traditionalist Baby Boomer Gen X Millennial Check here if you would like to have cocktails/dinner on October 8 with other participants Cancellation Policy: If received by September 1, 2015 or earlier: full refund. September 1-17: 50% refund. After September 18, no refund, but payment can be applied to future training. FORM SUBMISSION DETAILS Please email completed form, short bio, and headshot to barbara@2164.net
2164-Facilitation-Training-registration-form.docx