Kachina Chapter 28

Course Registration Form - Generic

To register, complete this form and email to education@irwachapter28.org or to the class coordinator.

To pay by Check, mail this form with a check payment to: IRWA Chapter 28, Attn: Education,
24 W. Camelback Road, #A-428, Phoenix, AZ 85013.

To pay by Credit Card, include your card information on this form when submitted for registration, OR go to:

http://www.irwachapter28.org/education_classes.asp
and pay securely and privately online by selecting the appropriate Paypal payment link at bottom of page.

Your Information
Course Information
Name:
Course Number:
Title:
Course Dates:
Membership #
Course Location:
Company:
Registration Fee:

$
Address:
Total:
Address 2:
City:
State/Province:
Zip/Postal Code:
One Day Class =	$265.00
Phone:
Two Day Class =	$415.00
Fax:
Three Day Class = $565.00
E-mail:
Four Day Class =	$755.00

Please confirm my registration by: E-mail	Phone	Fax

Payment Type: Check (included) Paypal (online)	Credit Card: Visa MC AmEx

Card Number:
Expiration Date:
CVV Code
Name (as it appears on card):
Billing Address

Signature:

Amount to be charged:

Class Cancellation & Tuition Refund Policy

Cancellation Policy: All classes scheduled by IRWA are subject to cancellation. All class registrants are encouraged to contact the Course Coordinator prior to making travel arrangements, keeping in mind that the class may be canceled at any time(for reasons including, but not limited to, insufficient registration, Facilitator emergencies or other issues beyond the control of the chapter and/or IRWA). Fully liquidated damages for any losses incurred by a class registrant are limited solely to a refund of the registrant’s prepaid class tuition. IRWA and its chapters assume no other registrant liability resulting from class cancellation.

Refund Policy: Written notification of intent to cancel registration must be received by both the Course Coordinator and Chapter Education Staff (education@irwachapter28.org ) prior to the class start date in order to be eligible for a tuition refund. A full tuition refund will be issued if notice is received 15 days or more prior to class start date; a 75% refund will be issued if notice is received less than 15 days prior to the class start date; and no refund will be issued for notice received on or after the class start date.

Belinda

2015-08-06

MomandMeg

IRWA