Canine Behavior Evaluation, St. Louis, Missouri

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Registration Form

BEHAVIOR EVALUATION
Sue Sternberg
Saturday & Sunday • June 18th & 19th, 2011
Humane Society of Missouri • St. Louis, Missouri

First Name:
Last Name:
Business/Organization:
Address:
City:
State/Province:
Zip/Postal:
Work Phone:
Home Phone:
Email:
Method of Payment: Visa Mastercard Check in the Mail
Account Number
Expiration Date
Validation Code	Last 3 digits on signature panel.

*SEMINAR FEES*
*Saturday & Sunday • June 18th & 19th, 2011*
	Saturday & Sunday Early Bird discount until May 25	$175.00
	Saturday & Sunday After May 25	$195.00
	Saturday & Sunday with Lunch Early Bird discount until May 25	$199.00
	Saturday & Sunday with Lunch After May 25	$219.00
*Saturday • June 18, 2011*
	Saturday Only Early Bird discount until May 25	$90.00
	Saturday Only After May 25	$105.00
	Saturday Only with Lunch Early Bird discount until May 25	$102.00
	Saturday Only with Lunch After May 25	$117.00
*Sunday • June 19, 2011*
	Sunday Only Early Bird discount until May 25	$90.00
	Sunday Only After May 25	$105.00
	Sunday Only with Lunch Early Bird discount until May 25	$102.00
	Sunday Only with Lunch After May 25	$117.00
*And dont forget...*
	Please send me more brochures to share with friends and colleagues.
	Notes/Special Requests:

An email confirmation will be sent to you for your files.

Please complete this registration form and mail in a check or provide us with your credit card number above. You can also phone or fax us your registration and payment information.
Please make checks payable to:

Petworkshops, LLC / Puppyworks
PO Box 938
New Paltz, NY 12561

email: events@puppyworks.com
phone: (917) 699-6440
fax: (845) 255-4920

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