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Training Cancellation Form Train=
ing
Date:____________________ Train=
ing
Name:___________________ Regis=
trant
Contact Information
Name:=
&=
shy;_______________________________________________=
________________ Agenc=
y:_____=
___________________________________________________________ Addre=
ss:_____=
____________________________________________________________ City:=
_____=
________________________________________________________________ State=
:_____=
_______________________Zip:___________________________=
_________ Email=
:_____=
______________________________________________________________ Phone=
:_____=
____________________________________________________________ Fax:____=
________________________________________________________________ _____=
___________________________________________________________________________=
_ Regis=
tration/Payment
Information Regis=
tration
Date: ____________________ Regis=
tration
Confirmation Number/Approval Code:____________________ Payme=
nt
Processed (Circle One):
Yes/No Payme=
nt
Amount: $____________ Payme=
nt
Type: o&=
nbsp;
<=
span
style=3D'font-size:14.0pt;font-family:"Book Antiqua";color:#004263'>Credi=
t Card
Type (Circle One): Visa/=
MasterCard/American
Express o&=
nbsp;
o&=
nbsp;
o&=
nbsp;
<=
span
style=3D'font-size:14.0pt;font-family:"Book Antiqua";color:#004263'>Check=
: o&=
nbsp;
Check Holder/Credit Card Holder Contact Information (if different than above):<= o:p>
Name:=
_____=
______________________________________________ Agenc=
y:_____=
__________________________________________________________________ Addre=
ss:_____=
___________________________________________________________________ City:=
_____=
_______________________________________________________________________ State=
:_____=
Zip:___________________________=
__________ _____=
___________________________________________________________________________=
_ CATALYST FOR CARE CANCELLATION P=
OLICY Payment is expected on all
registrations unless notification of cancellation is received no later th=
an 7
days prior to the workshop. No shows will not be given refunds or allowed to transfer registra=
tion
to another workshop. If for any reason you or your st=
aff
cannot attend, you may send a substitute. Please notify Catalyst for CARE=
staff
of the change. |
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catalystforcare.org
| site design: |
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<=
![endif]>![](3D"trcancellationform_files/image002.jpg")
<=
![endif]>![3D"Catalyst](3D"trcancellationform_files/image003.jpg")
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