Corporation for Positive Change Workshop Registration Form

Please print and either mail or fax the completed form with payment to:
Corporation for Positive Change, 7398 S. Zephyr Way, Littleton, CO 80128

303.978.9543 (fax) 303.972.5155 (voice)

1. Attendee Information:

Name (please print):

Title: Organization:
Address:
City: State: Zip code:
Phone: Fax: Email:

2. Workshop Information:

Title of workshop: 
Dates: Location:
Workshop fee: Special dietary requirements:

3. Payment Information:

• To pay by check, make checks payable to: Corporation for Positive Change
• To pay by credit card, fax this form to: 303.978.9543

Visa MC No. Exp. Date:
Signature: Verification Code:
Name on Credit Card:

REFUNDS: An 80% refund for cancellations up to 30 days prior to the workshop; 50% thereafter. No refund for cancellations within one week of the workshop.

SUBSTITUTION FEE: $75.00 will be charged to substitute one person for another, once a registration is received.

CONFIRMATION: We will confirm your registration within three business days. If you have not heard from us within that time frame, please contact us at office@positivechange.org or call 303.972.5155.