registerForm

Name:

Mail:

Title:

Nickname:

Company Name:

Approx Annual Volume:

Address:

City/State/Zip:

, ,

Telephone:

Fax:

Email:

Seminar:

City of Seminar:

Date of Seminar:

Price:

$2,500.00

You can pay with a MasterCard, Visa or a check. Please mark the box below to indicate your preferred method of payment. If you prefer to pay with a credit card, please call us with the number or follow this link to pay online shop.leeevansgroup.com . However, if you prefer to fax or mail this form, you may include your card number with the registration form. Please print and fax this form to 303.972.7667, or to pay with a check mail it to: The Shinn Group, 6637 W Hinsdale Ave, Littleton, CO 80128.

Method of Payment:

Credit Card

Card Type:

Card Number # Exp. only if faxing or mailing

I will mail a check or call with credit card number