SERVICE COURSE REGISTRATION FORM

 

NAME(S): 1)  2) 3)
  4)  5) 6)

 

COMPANY:
  
 
ADDRESS:
 

 
CITY: STATE: ZIP CODE:
PHONE:                             EMAIL:  
     


 

COURSE DESCRIPTION:
 
 
COURSE DATES


PAYMENT OPTIONS

A CHECK PAYABLE TO INTERSPIRO, INC. FOR $, TO BE MAILED ON .

 

CREDIT CARD:
     		CREDIT CARD NUMBER
 
EXPIRATION DATE:

 

PURCHASE ORDER NUMBER:

Please note that registration and payment must be made no later than three weeks prior to the date of the class.  Cancellations made after one week prior to the class will be subject to a cancellation fee.

Please mail checks to:    Interspiro, Inc.
                                               10225 82nd Avenue
                                               Pleasant Prairie, WI. 53158-5800