Late Registration for 1

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1-(800)-370-3574

: To Register:

Step 1: Please enter and submit all information.

Step 2: Payment

a) To pay by credit card, enter your card # into the fields below.

b) To pay by purchase order, submit registration, then thtthen please fax P.O. to (503)-977-2941 or mail to:
CET, 1825 Englewood Court. Lake Oswego, OR 97034

Step 1		LATE REGISTRATION

First Name * Person making registration		Last Name * Person making registration

First Name 1 * Person Attending Seminar		Last Name 2 * Person Attending Seminar

Street Address *		Apt./Suite #

City *		State *

Zip Code *		How would you like your confirmation? *

Home Phone * With area code		Work Phone With area code

E-Mail Address *		Fax

Grade (or Title)		City and Date of Seminar *		Price:$169.00

Step 2

Method of Payment *		Purchase Order # & Billing Address A copy must still be faxed or mailed.

Card		Card #:		Security # *		3 Digits		EXP Date:

Name on Card/Billing Address:

District		School

How did you hear about this? Flyer, Friend, Web,...		Comments

* Required to submit this form