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Name:
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Company
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Job Title:
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Address:
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City:
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State: Zip: County:
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Area Code:
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Phone:
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Email Address:
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Authentic Thinking for Creative Evolution 2007-2008
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If printing this form, please check your course location: Los Angeles or New York City Select option 1, 2, 2b or 3 below (all tuition and enrollment fees are nonrefundable)
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Click button to pay online with your credit card through PayPal - does not require a PayPal account
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Tuition Options
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Tuition
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PayPal
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Option 1 - Initial $500 enrollment deposit by August 31 - Holds your place in the course and applies to tuition - Full tuition must be paid before the first seminar
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$500
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Los Angeles
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New York
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Option 2 - Course tuition with early discount by August 31. Includes $500 discount when tuition is paid by August 31 - Holds your place in the course
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$4,000
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Los Angeles
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New York
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Option 2b - 2nd person, same household & early registration discount - $500 discount for person from the same household: i.e., married, engaged or significant other - Also includes $500 discount tuition if paid by Aug. 31 - All the benefits listed in Option 1 and 2
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$3,500
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Los Angeles
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New York
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Option 3 - Course tuition paid after August 31 Full tuition must be paid before start of the first session.
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$4,500
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Los Angeles
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New York
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Total
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Payment Method: __Check (payable to Vision In Action) __ VISA __ MasterCard
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Credit Card Information
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Name on card (and address if different than above) :
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Card No.:
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Expiration Date:
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Verification Code:
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Signature:
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(last 3 digits on back of card near signature or 4 digits above embossed account # on front)
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