Relationship Institute Workshop Registration Form

Workshop Registration Form

Register Early - Enrollment is Limited

Fill out the following form, print it and mail or fax to us.

I'd like to register for the Workshop

Tell Us About Yourself

Name:

E-mail:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Status:

Tell Us About Your Partner

Partner's Name:

E-mail:

Partner's Address:

Check if same as above information.
If different please complete the following:

Partner's Address:

Partner's City:

Partner's State:

Partner's Zip:

Comments/Questions

Who can we thank for recommending us to you?

Cost & Confirmation

A $375 deposit is due with this registration form. The balance of $375 is due 3 weeks prior to the workshop. After you fill in the form above, print this form and fax to (520) 795-3575 or mail to the address below with your check or money order. You can pay the deposit by Visa or MasterCard by providing the following information:

Name:

Card:

Credit Card Number:

Expiration Date:

Signature:

To pay online with our secure payment system visit:

www.imagopartners.com/payment.html

(Options include deposit, final payment, or payment in full.)

info@imagopartners.com

(520) 881-6111
Fax: (520) 795-3575

Relationship Institute
5210 East Pima, Suite 115Tucson AZ 85712