Service First Education and Training                            
                     Office: 1-800-729-1949    Fax: 704-596-4490   
                                    Email: sftng@aol.com    

            
    Workshop Title, Location, Date,  Time and Fees for Thursday, April 21, 2011:
           Parent Involvement - Myrtle Beach, SC - 4/21/11 - 12:30 PM - 4:30 PM - $41.00 Per Person
 
      Name(s) of Participant(s):

      1.            2.        3.

      4.           5.          6.  

      7.           8.           9.

      10.        11.       12.  
 

    Workshop Title, Location, Date, Time and Fees for Friday, April 22, 2011:
           Challenging Behavior - Myrtle Beach, SC - Friday - 4/22//11 - 8:30 AM - 12:30 PM - $41.00 Per Person

    Name(s) of Participant(s):

     1.          2.          3.

     4.            5.        6.  

     7.            8.         9.

     10.        11.      12.  
   

    Workshop Title, Location, Date, Time and Fees for Saturday, April 23, 2011:
           Turn it Around - Myrtle Beach, SC - Saturday - 4/23//11 - 8:30 AM - 12:30 PM - $41.00 Per Person

    Name(s) of Participant(s):

     1.          2.        3.

     4.          5.       6.  

     7.          8.        9.

     10.       11.     12.  

    School /
    Organization        Mailing Address 

     City               Select Your State   Alabama Arkansas Florida Georgia Kentucky North Carolina Ohio South Carolina Tennessee Virginia             Zip Code 

     Telephone #             Fax #  

     Email Address            Email Contact Person     

     Please Note: Credit Card Number, 3 Digit Card Code, Expiration Date,
     Card Holder's Address, Card Holder's Zip Code, and Card Holder's Name
     must be submitted in order to complete registration and receive email confirmation.

     Select Credit Card           Visa MasterCard Amex Discover             Amount $

     Card Number                  ---

     Expiration Month   January February March April May June July August September October November December          Expiration Year  2011 2012 2013 2014 2015 2016         3 Digit Card Code  

     Card Billing Street Address

     Card Billing Zip Code  

     Card Holder's Name

     Please Note:
     1.  Review the information you entered on the form before clicking the submit button.
     2.  Click the submit button only once.
     3.  After you click the submit button, , a "Form Confirmation" page showing the
          information that you entered will appear. Please review the information and print
          a copy for your records. This is not an official confirmation.
     4.  After your credit card is processed, an official confirmation will be sent to the email
           address entered on your form within 24 hours. 

      Thank you, and we appreciate your business.
      Service First Online Registration Team