| There are special rates for two or more group numbers, company attendees, students, and senior citizens. Contact us at info@cfhd.org or call 740-838-4033 M-F 9AM to 4:00 PM EST. Or leave your information on voice mail and we will call you back. |
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| A. PROGRAM REGISTRATION |
| Name of Program |
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| Dates Attending |
How did you hear of this program? |
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| Name of your sponsor or person who referred you |
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| B. PERSONAL DATA |
| Your Name (As appears on legal papers and drivers license) |
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| Address |
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| City |
State/Province |
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| Zip Code |
Country |
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| Home Phone |
Business Phone |
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| Mobile Phone |
Email |
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| C. WEB PROFILES |
| Your Web Site URL |
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| *No web site? Want to create the opportunity for your business and career needs? Let us know and we can provide resources for you and personal consulting to assist in the developing and top positioning in Search Engine Optimization! Call Bashie and Mary at 614-751-7900!!!! |
| D. COMPANY INFORMATION |
| Name of Business or Employer |
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| What position do you hold or your job title and description |
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| E. CREDIT CARD DATA |
| Visa/Mastercard Number |
Expiration Date |
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| Last three digits on back of card |
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| Credit Card Billing Address |
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| Name of Cardholder/Signature |
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| How many people are you registering? |
Note if you are within any advertised benefits time lines |
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| F. EDUCATIONAL CREDITS |
| What educational or business credits will you be requiring? |
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| G. PARTICULAR CONSIDERATIONS |
Please inform us if you have any considerations needed, such as
interpreting services, (spoken & signed languages),
wheel chairs,
sight and seeing needs,
Special diet needs.
State below the particulars and we will contact you with further clarity. |
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H. LODGING
How many adults and children for which nights. |
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Date and Signature |
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If you are filling out this form on web site, please also make a hard copy and fax it to us with your signature, to fax number 614-751-7905.
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We appreciate your co-operation in assisting us to serve you.
*** This denotes areas where the information is not mandatory, it is used to assist us in our demographic studies that help us bring in quality seminars to our area, to secure our communities' financial growth and success. So if it is not comfortable to you this area need not be filled in.
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