Registration

Critical Mass 2002 Registration Form
Please submit one form per person

* required fields
*Name
Program/Company
*Address
*City
*State
*Zip
Work Phone
Home Phone
FAX
*Email

Terms of Enrollment & Cancellation Policy READ CAREFULLY!

Please enclose tuition and separate enrollment form for each participant. Workshops space is limited and enrollment is limited to a first paid, first enrolled policy.
Visa and Mastercard are accepted and are subject to the same conditions as cash or checks.
Purchase orders are accepted but funds must be received a minimum of 30 days prior to the start of the event for the participant to be admitted. Purchase orders are subject to all of the same terms as cash, check and credit card payments. Purchase orders requiring additional invoicing are subject to a $10 processing fee.
All workshops have a minimum enrollment number of 10 participants. Any cancellation entitles the participant to a full refund or transfer to another workshop.
Meals, lodging and continuing education credits are available separately and are not included in the daily workshop fees.
Refund policy: Written request must be sent for any refund (call first). Tuition minus a $50.00 processing fee is refundable up to 30 days before the start of Critical Mass. Refunds from 29 days to eight days before Critical Mass are issued less a $100.00 processing. Cancellations within seven days of the start will be subject to a 50% penalty. "No shows" and Cancellations after the start of Critical Mass will receive no refund.
Submitting your enrollment in Critical Mass binds you to the terms of these policies.

Workshop List

	Workshop Title	Workshop Date	Cost
	Helping Organizations Build Teamwork	April 11th	$150
	Rhythm of Life	April 11th	$135
	Christian & Challenge Course	April 11th	$135
	Games For Teachers	April 11th	$135
	Corporate Training & Development	April 12th & April 13th	$295
	Elements of Choice	April 12th & April 13th	$275
	Physical Confidence Therapy	April 12th & April 13th	$250
	DiSC – Personal Profile System	April 12th & April 13th	$495
	Affordable Portables with Youth	April 13th	$135
	Becoming a Change Agent	April 14th	$135
	Technical Skills Review	April 14th	$135
	We're All in the Same Boat	April 14th	$135
	Noodle Mania	April 14th	$135
WORKSHOP TOTAL: $

Early Bird Discount Program

Enroll by March 1st and save! Payment must be postmarked by March 1st to receive the discount.

If you enroll in:	You receive off of your workshop total
Two days of training	$50
Three days of training	$75
Four days of training	$100
NOTE: Only one discount is allowed per participant.	Total Discount Allowed: $
Final Workshop Total: $ (Workshop Total minus Discount Allowed)

Lodging

Lodging is available at:

Extended Stay America

3747 29th SE
Kentwood MI 49512

616-977-6750

Book by phone:
800 398-7829
request Kentwood MI

Single $49
Double 1 bed $54
Double 2 beds $59; harder to get -- book early

Includes: full kitchens, cable, data port, free local calls

Meals Only

Lunch will be available at the workshop site for $8.00 per day.

Total Meals: $
($8 multiplied by number of lunches)

Dinner options are available around the area. We will organize a different restaurant each evening for everyone to congregate, mix, and mingle.

Calculate Form Total

Payment Method

Total Enclosed: $
Please bill my Visa Mastercard Card #
Exp. Date
Include as it appears on monthly statements:
Name printed on Credit Card
Street/Address
Zip

Mail or Fax Registration and Payment to:

Leahy & Associates, Inc. •1052 Artemis Circle • Lafayette, CO 80026-2840

Phone: 303-673-9832 • Fax: 303-604-1901 • email: info@leahy-inc.com