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        Bridgefield Group Public Education registration form

Registration options:

• Call (770) 649-7852 to register and pay by credit card

• Print and mail this form (one form for each student) with check (US funds only) or credit card information to:

Bridgefield Group Inc.
Attn: Registration
270 Lakeview Ridge East
Roswell, GA 30076

• Print and fax this form with credit card payment information to (770) 649-7853

Course name
Course location
Course dates
Attendee name
Title
Company name
Company address 1
Company address 2
City
State/Province and Country
Postal code
Attendee phone number
Confirmation method: mail, fax, e-mail
Attendee fax (if applicable)
e-mail for confirmation
Payment method (check or credit card)
Type of credit card: Visa, MasterCard, American Express
Card number
Expiration date (month/year)

Cancellation policies:

Due to commitments required to reserve hotel conference facilities, the following cancellation policies are
in effect: 1) Substitute attendees from the same company may be made at any time 2) Cancellations may
be made up to 30 days prior to the class with no penalty 3) Cancellations made between 30 days and 15
days prior to the class are subject to $150 administration fee 4) Cancellations made less than 15 days
prior to the class (or no shows) are subject to fee of 50% of total course duration cost.

The Bridgefield Group reserves the right to cancelled scheduled classes as required.

 

Copyright©2006 Bridgefield Group Inc. All rights reserved.