Audiometric Baseline Consulting Registration Form

(Print and fill out the information and send with Check or Money Order to ABC). Indicate with an "X" which workshop you will be attending:
April 2008----------- 20 Hour Workshop -
April 3-> 5, 2008 $550.00
April 3& 4 - 8:30am to 5:30pm
April 5- 8:30am - noon
----------- 8 Hour Workshop -
April 4, 2008 $350.00
8:30am to 5:30pm

June 2007----------- 20 Hour Workshop -
June 5 -> 7, 2008 $550.00
June 5 & 6 - 8:30am to 5:30pm
June 7 - 8:30am - noon
----------- 8 Hour Workshop -
June 6, 2008 $350.00
8:30am to 5:30pm

>Sept 2007----------- 20 Hour Workshop -
Sept 11 -> 13, 2008 $550.00
Sept 11& 12 - 8:30am to 5:30pm
Sept 13 - 8:30am - noon
----------- 8 Hour Workshop -
Sept 12, 2008 $350.00
8:30am to 5:30pm

>Nov 2007----------- 20 Hour Workshop -
Nov 20-> 22, 2007 $550.00
NOV 20 & 21 - 8:30am to 5:30pm
NOV 22 - 8:30am - noon
----------- 8 Hour Workshop -
Nov 21, 2008$350.00
8:30am to 5:30pm

Name: ______________________________________

Title: __________________

Home Address: _________________________________________________

Home Phone: __________________________________________________

Work Phone: __________________________________________________

Place of Employment: _____________________________________________
Make Check or money order payable to: Audiometric Baseline Consulting
2754 South Park Road,
Bethel Park, Pa. ,15102