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We do not have the facilities for secure on-line registration. Please print this form, fill it out, and send it along with payment information to The Reilly Group using the address at the bottom of the page. Wetland Delineation TrainingNovember 12 through 16, 2001Registration FormLast Name___________________________First Name___________________Middle Initial____ Company/Affiliation______________________________________________________________ Company Mailing or Home Address_________________________________________________ City_____________________________________________ State ____________ Zip_________ Country ___________________Phone___________________Fax________________________ Email (confirmations cannot be sent without an e-mail address)___________________________ Name as you wish to appear on Badge _____________________________________ Hotel Reservations must be made directly with the Holiday Inn by calling 1-800-548-3030. Registration Fee for this training course is US $750.00 and includes: Training (4.5 days) and Materials
Payment must accompany this registration form. No registration will be considered complete until payment is received. Payment in full is required prior to the beginning of training. Refund Policy: Written request for cancellation received prior to October 31, 2001 will entitle the registrant to a full refund or registration in a subsequent class. No refunds after October 31st, however substitutions will be considered on a case-by case basis. FORM OF PAYMENT: CIRCLE TYPE OF CREDIT CARD MASTERCARD VISA AMERICAN EXPRESS Credit Card Number:______________________________________ Expiration Date:________ Name as it appears on the card:___________________________________________ Signature:________________________________________________ Date:_____________ Print this form out. Fill it in. Fax or mail it to: The Reilly Group 67 Meyer Lane Stafford, VA 22554-3430 (540) 286-0072 Voice (540) 286-0073 Fax Frank@TheReillyGroup.net Internet mail |
Contact InformationThe Reilly Group
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