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ND ALMUNI REGISTRATION FORM

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Doctor Attending
Name:________________________________

Guest(s) Attending (Co-Attendees)


(We strongly suggest bringing your spouse or leadership team only)
Name: ________________________________ Position/Relationship________________________________________
Name: ________________________________ Position/Relationship________________________________________

DOCTOR BOOTCAMP TUITION $1,990.00 .


Discount Opportunity:
• Alumni Discount – Deduct $1,100 - $1,100.00

DOCTOR ATTENDING (TOTAL A): $ 890.00


A =___________

GUEST(S) BOOTCAMP TUITION $495.00 ea .


# of Co-Attendees $495.00 x ________ =___________
Additional Discount Opportunities:
• Alumni Discount – Deduct $100 each Co-Attendee - __________

GUEST(S) (TOTAL B): B =___________

DISCOUNTED BOOT CAMP TUITION TOTAL : A + B = $___________

Payment Options:
____ Single Pay Option: A $50 Bookkeeping Savings will be applied to your total tuition when payment is processed.
____ 2 Pay Option: 50% will be charged when registration form received - remaining 50% to be charged 30 days later.
____ 3 Pay Option: First 1/3 will be charged when registration form received.
Second 1/3 be charged 30 days later – Final 1/3 be charged 60 days later.
Payment Information:
 Please use my credit card on file (Signature Only)
 Visa  MasterCard  American Express Discover Check (We suggest FedEx or Fax)

Credit Card # ______________________________________________________ Exp ____________


Signature _________________________________________________________ Date ___________
Travel & Hotel Information Will Be Faxed w/in 24 Hours of Receipt of Registration Form.
All Tuition is Non-Refundable Within 60 days of Scheduled Event.

RESERVE YOUR SEATS TODAY! (ALUMN


ALUMNII D
DIISCOUNTS EXP
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Scheduling
FAX TO: 770-518-7577 -or- CALL: 1-866-808-4084 Institute