Sensitivity Workshop Registration
 www.breakview.com
 

Pls note - an ' **** ' means field is required

Please Note: All registrations are payable by invoice only.

Billing Information (Name, Address):

Name

     ****
Company     ****
Address
City
State/Prov.
Country
Phone Number    ****

Email address

    ****

May we add you to our mailing list?

 Yes No

Select Workshop Location and Date

Canada

USA
  Toronto Calgary Ottawa Montreal Boston Chicago

Choose a date

 Mar 6
Apr 17
May 17
 Jun 12
 Sep 18
 Oct 23
 Nov 13		 May 11
Nov 23
 		 May 29
Apr 24
 		 May 24
 Jun 19
 Jul 18		 Apr 10
Jun 19
 Sep 25
 Nov 27
Workshop Participant(s) Information: (if different from above and if booking workshops only)

Attendee(s)

Cost

  CAD$575.00 plus GST per person
 US$490.00 per person

Payment Method

  Invoice only - Make cheque(s) payable to Breakview

Special Notes

Please indicate PO # and other pertinent details