Please remit this form with your fees by postal mail (if cheque or money order) or by fax (if credit card) to Stanford Solutions, only after reserving a place in the course and receiving a confirmation including your reservation number:

Personal Information
Name:
Organization:
Address:
City:
Province, Postal Code:
E-mail:
Daytime Phone:
Course Information
Course:
Date/City:
Reservation #:
Payment Information
Rate Qualification
Early Bird
Regular
Payment by enclosed cheque or money order made payable to Stanford Solutions.
<  > Cheque/Money Order
OR by credit card - complete all of the following information.
Card type	< > Visa <  > Mastercard
Card Number:
Expiry date:
Authorized Cardholder:
Print name:
Signature:

Please:

• Write payment amount by payment type above
• Describe any preferential rate in Rate Qualification
• Do not remit form and fees until you receive acknowledgement by e-mail that your space is reserved and include reservation number above and on all correspondence
• Advise of any dietary or food restrictions as soon as possible to ensure individual needs can be accommodated.

 
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Stanford Solutions is not affiliated with nor sponsored by Stanford University.
The principal of Stanford Solutions is named Xenia Stanford.
Last Updated: 22 march 2002
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