P O BOX 17286     PHOENIX   AZ     85011-7286
TEL: 602-279-3113 / 800-727-3113     FAX: 602-277-7502
Registration Form

The following printable form is provided for your convenience.  You may also register by phone or e-mail.
For details about the courses, please see our SCAN Training page.
Note:  All tuition fees are in US dollars.  For courses in Canada, or online courses where the student is in Canada, please add 5% GST.
Name:                                                                Company/Dept:
Tel:                                                                Fax:

Please register the following students:
#  of students Name of Course
Total Tuition
LSI Basic Course on SCAN   (tuition:  $600 per individual student,
$450 per student for groups of two or more)
LSI HQ Basic   (tuition:  $600 per student)
LSI Advanced Workshop on SCAN   (tuition:  $375 per student)
LSI Advanced Workshop Stage II   (tuition:  $500 per student)
LSI-AOC - The Art of Confession   (tuition:  $375 per student)

Note:  if paying by credit card, please include total tuition amount in appropriate space of "for credit cards" line in billing information section.  Thank you!
Course location:
Course date:
Names of Students (Please include company/dept, address and phone number, if different from that given in billing address.  You may attach additional pages if needed.):

Billing Information:
Company/ Department
City, State, Zip
Phone                                                                                 Fax
Please circle  type of payment:   cash       money order       check #                  purchase order #
For credit cards: Please bill my   Mastercard   Visa   AmEx   DinersClub   Discover   in the amount of US$
Name (as it appears on card):                                                                         Signature:   
Credit Card #:                                                                                                  Expiration Date:
[For office use:     Retrieval Code                                Authorization Code                                    Initials                     ]