HANDLE WITH CARE & Re-Certification Program” – “Instructor RICHMOND / VIRGINIA BEACH, VA - REGISTRATION FORM Please Fax completed Form to: Seminar Administrator @ 845-256-0094 When: Sept. 15 - 17, 2015 9:00 AM 5:00 PM – University of Phoenix- Richmond-Virginia Beach Training : 150 Central Park Avenue Virginia Beach, VA 23462 Lodging: Hilton Garden Inn Virginia Beach Town Center 252 Town Center Drive Virginia Beach, VA 23462 TEL: (757) 326-6200 NO BLOCK ROOMS RESERVED Cost: $1000 Per Participant *** TWO FOR THE PRICE OF ONE Special Promotion: WHEN REGISTERING FOR THE FULL PROGRAM *** Company Name: Address: City Zip Telephone: Fax: E-Mail: Participant/ Name(s): Cell or Dir.# ______________ Cell or Dir.# ______________ Wish to reserve the following slots: Name of Agency Days # of Slots Cost Day 1 Basic Verbal Training $300/person – Day 2 Basic Physical Training $300/person – Day 3 Instructor Certification $400/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: www.handlewithcare.com. By registering, my agency is obligating payment for the people. 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” RICHMOND / VIRGINIA BEACH, VA - REGISTRATION FORM Please Fax completed Form to: Seminar Administrator @ 845-256-0094 When: Sept. 15 - 17, 2015 9:00 AM – 5:00 PM Training : Lodging: University of Phoenix- Richmond-Virginia Beach 150 Central Park Avenue Virginia Beach, VA 23462 Hilton Garden Inn Virginia Beach Town Center 252 Town Center Drive Virginia Beach, VA 23462 TEL: (757) 326-6200 NO BLOCK ROOMS RESERVED Cost: $1000 Per Participant Special Promotion: *** TWO FOR THE PRICE OF ONE WHEN REGISTERING FOR THE FULL PROGRAM *** Company Name: Address: City Zip Telephone: Fax: E-Mail: Participant/ Name(s): Cell or Dir.# ______________ Cell or Dir.# ______________ Wish to reserve the following slots: Name of Agency Days # of Slots Cost Day 1 – Basic Verbal Training $300/person Day 2 – Basic Physical Training $300/person Day 3 – Instructor Certification $400/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: www.handlewithcare.com. By registering, my agency is obligating payment for the people. 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
09.15-17.15.RICHMOND.VA.semareg.docx