PRE-REGISTRATION
FORM
Please refer to the REGISTRATION
INFORMATION page for further details.
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= REQUIRED FIELDS
PLEASE
NOTE:
We have had irregular problems with our
server forwarding your pre-registration form to us. Please contact us to confirm that we have received your registration.
505-281-9844 or bhelmich@flash.net
SURVEY:
We are conducting a survey to help us
with our marketing efforts. Please help us by filling in the appropriate boxes
with an "X" below. Thank You
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SOURCE OF INFORMATION: |
WEB EMAIL FLYER FAXED FLYER MAILED FLYER COWORKER OTHER |
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DATE: |
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*SEMINAR TITLE: |
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SEMINAR LOCATION: |
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SEMINAR DATE: |
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*PARTICIPANTS NAMES/TITLES: |
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*TRIBES / ORGANIZATIONS: |
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*ADDRESS: |
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*CITY / STATE / ZIP: |
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*TELEPHONE / EXTENSION: |
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*FAX: |
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*E-MAIL OF PARTICIPANTS: |
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REGISTERED BY: |
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For questions concerning this
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BILL HELMICH ASSOCIATES
Last Modified
04/07/10