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or download the registration form as a Word® document to complete on your computer.

Delegate Information

* Delegate's name:
If you are registering for someone else, what is your name?
* E-mail address:
Phone:
Fax:
Mailing address:
City, State, Zip
Employer or Organization:
Job title:
The following information helps us to plan our sessions to best meet your needs:
Please provide 1-2 sentences about your experience with using emotional intelligence.
What are your primary objectives in attending this course?

Your Requested Seminar(s):

* Which Seminar would you like to attend?(Seminar Schedule)
Registration fee:
If it is available for this course, I would like the Service Discount -- here is what I will do to earn the scholarship:
How did you learn about this course?
If there are people looking to share a room, would you like us to attempt to connect you?	yes!
If you are coming with other people, how many people are in your group?

Payment

* Payment
Options: Pay with a Visa, Mastercard, or Amex -- provide a $500 deposit online now, and the balance of the fee will be charged 3 weeks before the course. Request an invoice for your school or business. Mail a check.
If using a purchase order, please enter the PO number:
Other payment note:

Any additional comments?

When you press "register," this form will be submitted to us by email.

If you are paying a deposit online, you will automatically go to the payment page, where you can choose how you would like to pay for the seminar and "check out" from the store.

We will email and/or fax you registration materials. If you have any question about your registration, please email us.

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