Seminar name ___________________________________________________
Date you will attend _______________________________________________
Seminar Fee $____________________
Your Name _____________________________________________________
Your best phone number ____________________________________________
Your best email address (Print neatly!) ____________________________________
Your credit card number (Print neatly!) _____________________________________
Expiration Date (mm/yyyy) ___________________________________________
Billing Address of your credit card (Street, City, State Zip Code)
________________________________________________________________
________________________________________________________________
Three-digit security number of your credit card ______________
For MasterCard or Visa, it's the last three digits in the signature area on the back of your card.
For American Express, it's the four digits on the front of the card.