Registration
Form

Tuition - Early Bird Special: 15 days prior to seminar --- $149
       Students with photo ID --- $75; Spouse or non-DC staff --- $75; Technique only --- $99
       D.C's --- $245; Refresher Doctor --- $119 + $20 for notes = $139

Tuition - Regular: At door or within 15 days of seminar --- D.C.'s $199 + $20 for notes = $139
       Students, Spouse, Non-DC Staff --- $100; Technique only --- $150
       Refresher DC --- $169 + $20 for notes = $189

* All seminars include notes and lunch

Please fill in all applicable boxes and submit:

Name   

Address 

City    

State   

Zip Code

Phone  

Fax     

Email   

Seminar Date & Location   

Do you need Continuing Education credits for this seminar?
    Yes      No

School and Year Graduated 

Birthday Month 

CA License #   

Student, Spouse, or Staff Names 

Credit Card #    Type
     Exp.Date    Card Verification Number What’s this?

If paying by check: Make payable to Triad Seminars and Mail to
Triad Seminars, 25283 Cabot Rd., Ste. 109, Laguna Hills, CA 92653

                

Refund Policy: No Returns 7 days prior to seminar. Refunds requested prior to 7 days will be refunded at 75% of fee. Or 1 year credit will be issued. Re-licensing credits may be applied for in other states upon request. Re-licensing credits granted through Triad Seminars.