Intervista - Educational Programs

To register for one of our courses, please complete the form below. Online registrants will be contacted by phone within 48 hours to confirm the registration and obtain credit card information for payment, so be sure to include your telephone number and e-mail address. Payments may be made with American Express, MasterCard, Visa or EnRoute credit cards. Receipt of your payment constitutes confirmation of your enrolment. The location of the course will be included in the confirmation to you.

To register by phone call 1-800-397-9744.
To register by fax call 1-800-397-9389.

Click here for a printable version of this form.
See our full Calendar of Programs


REGISTRATION FORM – EDUCATIONAL PROGRAMS

Course:
Date(s):
City:

Salutation:
First Name:
Last Name:
E-mail:
Title:
Organization:
Division / Directorate:

Street Address:
City:
State (Province):
If other, please enter:
Country:
If other, please enter:
Zip/Postal Code:
Telephone:
Fax:

VIP Number (printed on the label of mailed brochure):

Name of person making registration (if different from above)
Salutation:
First Name:
Last Name:
E-mail:
Telephone:
Fax:

Invoicing contact - if different from above
Salutation:
First Name:
Last Name:
E-mail:
Telephone:
Fax:

Invoicing address - if different from above
Street Address:
City:
State (Province):
If other, please enter:
Country:
If other, please enter:
Zip/Postal Code:

How did you learn about this course? (You may select more than one)
	By Fax Advisory
	By Mail (brochure)
	By Email
	Referred by Colleague
	Intervista Website
	Search Engine
	Other

Would you like to receive regular e-mail updates about our programs?
	Yes, add me to your mailing list

If you are GST exempt, provide GST Exemption Number below - or fax a letter with statement of exemption to 1-800-397-9389.


Your message:

REGISTRATION - NOTICES

• To register more participants, please submit and complete a new form.

• All applicable taxes are extra. Substitutions may be made at any time. Cancellations are accepted up to two weeks prior to the course. A $100 service charge will be applied.

• All cancellations must be made in writing by e-mailing info@intervista-institute.com or by faxing 1-800-397-9389.

• Late cancellations will not be refunded, but enrollment fees may be credited to any future Intervista course. Intervista Inc. reserves the right to postpone, cancel or change scheduled dates or venues, as well as the right to substitute course leaders with other qualified experts.

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