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