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 Seminar Registration Form

Please Print Clearly  and Send this form to:

Mr. Terry Winders
9008 Denington Dr.
Louisville, KY 40222

Your registration will be confirmed by e-mail.
Please call 502-327-9666 if you do not receive a confirmation.

Attendee information:
Name: ____________________________ Title: ___________________________
Name: ____________________________ Title: ___________________________
Name: ____________________________ Title: ___________________________
Name: ____________________________ Title: ___________________________

Company Name: _______________________________
My business is primarily: [ ] small ticked, [ ] Middle Market [ ] large ticket
Is your business [ ] direct [ ] vendor [ ] captive [ ] bank [ ] independent [ ] funder
 
Attendee Mailing Address: ___________________________________________ Apt. #: ___________
City: ______________________________________ State: ______________
Zip Code: ___________________
Phone: ______________________ E-mail: ________________________________

Payment information: Payment is due by the seminar date. *
Check: Make payable to Winders Consulting Co., Inc.
Credit Card: (Please circle) Visa, Master Card
Credit Card #: _____________________________________
     Security Code: __________ Exp. Date: _____/_____
     Name on Card: __________________________________________________
     Card Billing Address: ______________________________________________
Seminar information: Include the date and name of the seminar(s) you are registering for.
Date: Seminar Name: Seminar Fee:
___________ _______________________________________ $____________
___________ _______________________________________ $___________