PI | Training Program

Register here for the Performance Institute training program named above. Please select the dates you'd like to attend from the options listed (if applicable).

November 17-18 , 2004
Arlington, Virginia (Code: C138)

Name:

Title:

Organization:

Address:

Address (cont'd):

City:

State: Zip:

Phone:

Fax:

E-mail:

How did you
learn about the program?

*REQUIRED

If you selected "brochure" or "faxed flyer," please find the
"Priority Code" written near your name on the brochure or fax and enter it here.
Please enter that code here:

Payment Information:

	Credit Card
	Check
	Purchase Order/Training Form

Credit Card
Number:

Expiration:

Name on Card:

Please let us know in the "Comments" field below if you would rather not send credit card information over the Internet.

Cancellations: A 10 percent charge will be assessed on your conference registration fee for any cancellation within 3 weeks of the event.