Registration

Workshop you plan to attend:
  • Name ________________________________________________________________
  • Date ________________________________________________________________
  • Place _______________________________________________________________
  • Presenter ___________________________________________________________
Your information:
  • Name ________________________________________________________________
  • Address _____________________________________________________________
  • City, State, Zip ____________________________________________________
  • Email _______________________________________________________________
  • Phone _______________________________________________________________
  • I need CE’s for this workshop ___ Yes ___ No
  • Profession __________________________________________________________
Payment Information:
  • Check for $ _________ is enclosed.
  • Bill my credit card for $ ____________ Mastercard ___ Visa
Name as it appears on credit card ________________________________
	Credit Card Number _______________________________________________

	Expiration Date __________________________________________________
NOTE: Billing will be listed on your credit card bill as National Institute of
      Relationship Enhancment (NIRE)

SEND: Registration by FAX to 502-226-7088 or email to admin@skillswork.org or mail to:
      IDEALS, 306 W. Main Street, Suite 507, Frankfort, KY 40601
QUESTIONS: call 502-227-0055