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4th
International Congress Pre-Registration Form
Title
First Name:
Last Name:
Institution
Address 1:
Address 2:
City:
State:
Zip:
Country
Phone:
Email:
You will receive an e-mail confirmation within 1 - 3 business
days from Continuing Education.
This registration will hold a space for you in the selected
class(es) for 1 week.
The Division of Continuing Education requires payment in
advance for all classes.
Registration Deadline:
March 1, 2010
Your $250 Congress registration fee will include the following:
· Congress
sponsored materials
· A
reception
· All
open sessions
· Two
continental breakfasts
· Two
lunches
· One
dinner
Please make your check payable and mail
with printed form to:
Clarion University of PA
Continuing Education/4th
Congress
840 Wood Street
Clarion, PA 16214
Check here, if you prefer to pay with a credit card,
and someone from our office will call you.
We can accept Visa, MasterCard, American Express and Discover over the telephone.
Please enter any additional information or questions below:
CANCELLATIONS
All
cancellation requests will be subject to a $25 processing fee.
Cancellations received after March 1, 2010 are subject to a $50
cancellation fee. No refunds will be honored after March 15, 2010
PLEASE NOTE: ALL CANCELLATION REQUEST MUST BE IN WRITING.
CONTACT
INFORMATION
Phone:
(814) 393-2227 or
Toll Free 800-672-7171 (option 5, then option 1)
Fax: (814)
393-2741
Email:
continuinged@clarion.edu
For more
information:
http://www.clarion.edu/77181/
Please Print this form for your records before hitting the Send button.
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