a one day experience to gain clarity for your life and work
I'm registering for the following PAUSE Experience: Date: Select One... December 2-4, 2008 Email Address: Attendee Name: Home Address: City: State/Province: Select One... AL Alberta AK AZ AR British Columbia CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD Manitoba MA MI MN MO MS MT New Brunswick Newfoundland NE Northwest Territories NV NH NJ NM NY NC ND Nova Scotia Nunavut OH OK Ontario OR PA Prince Edward Island Quebec RI Saskatchewan SC SD TN TX UT VT VA WA DC WV WI WY Yukon Territory Zip/Postal Code: Daytime Phone Number: Cell Phone Number: Organization Name: Payment Information PAUSE Registration: $650 *$200 deposit required to hold your spot – deposit is refundable up to 30 days before event Count me in for the optional PAUSE Facilitator Training: $500 in addition to PAUSE How Should We Charge You: $200 Initial Deposit Entire Amount * By filling in the above information I grant authorization to charge my credit card the amount indicated. The balance can be paid by check, cash or credit card the day of the event. Deposit is refundable up to 30 days before event. Form of Payment: Select One... Visa MasterCard Discover Mail a Check Credit Card Payment Information Name on Card: Card Number: Expiration Date: 01-JAN 02-FEB 03-MAR 04-APR 05-MAY 06-JUN 07-JUL 08-AUG 09-SEP 10-OCT 11-NOV 12-DEC / 2007 2008 2009 2010 2011 2012 Security Code: Billing Zip Code For Card: Your PAUSE confirmation and travel details will be emailed upon receipt of your registration. Questions? Call 616-335-8500
550 Old Orchard Rd, Holland, MI 49423 616.335.8500dan@authenticleadershipinc.com