RiverWays Enterprises Registration Form

Ticket #_____
RiverWays Enterprises Seminar Registration
Welcome and thank you for your interest in the Speaking with Confidence for Results program. Since this is not a secure site, please do not send payment information by email. Instead, print and complete this form, then either fax it or send it in by regular mail. If you intend to fax it and have not notified us previously of your intent to register, please click here to advise us by email so that we can expect your registration.

Name:__________________________________

Work Phone:______________________________

Cell Phone:_______________________________

Company Name:__________________________________

Home Phone:____________________________________

Email Address:__________________________________

____ $2,195	Speaking with Confidence for Results Morning or Evening section (circle one) Starting Date __________
____ $1,995	Early bird price (if payment is received 14 days in advance) Starting Date __________

Payment Total: ________________________

Payment Method:

________	By check (payable to RiverWays Enterprises). Send to P.O. Box 79081, Belmont, MA 02479-0081.
________	By credit card (fax to 815-301-8929 or mail to above address). _____Visa _____Master Card _____American Express
	Card Number:________________________________________ Expiration Date:___________
	Signature:___________________________________________ Today's Date:_____________ Name as it appears on the card:_______________________________________________________ Billing Address:_______________________________________________________________________ _____________________________________________________________________________________

Cancellation/Withdrawal Policy: You may withdraw from the program with full refund less a $100 cancellation fee if you send us written notification (anne@riverways.com) at least one week prior to the first meeting of the program. Within the final week before the program, if you give us written notice at least 24 hours before the start date, you will be able to apply your tuition to any RiverWays program(s) within the next six months. If you do not give us at least 24 hours notice, you will forfeit your registration fee.

Newsletter subscription: By enrolling in any of our programs you will automatically receive a subscription to our newsletter, RiverWays News. Please notify us by email if you'd prefer not to receive this newsletter.