Seminar Registration Form
(completely fill out this form and print to mail with check or money order)


Algorithm Level Training Seminar ........... $400.00
(two day course)
date (mm/dd/yy) from schedule
location from schedule

name **
degree or position **
**
(these fields will be printed as shown on course certificate)
company
address
city state
zip/postal code
country
work phone
home phone
E-mail address


C
ompletely fill out this form and print to mail with check or money order to:

Quantum Performance Institute
8919 Fleetwing Avenue
Los Angeles, CA 90045

 
  Phone 310.568.1065
              
 Fax 310.670.1460

Cancellation policy: Fully refundable up to 2 weeks before date of seminar. After that time, fees may be applied to a future seminar.

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