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	Sales Training Workshop Registration
Select Workshops
Number of Attendees
Promotional Code	Optional Promo Code

Sales Training Workshop Registration

Total Registration Fee

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Are you currently working with a Business Partner?

Yes No

* Affiliate

Billing Information

Prefix:
* First Name:
* Last Name:
Job Title:
Company Name:
* Address 1:
Address 2:
Address 3:
* City:
* State:
	If outside of United States, please specify below: Note: Because you have selected a session that is outside the United States, we cannot process your credit card on-line. You can still use this form, but your only payment option will be "Invoice".
* Country:
* ZIP/Postal Code:
* Phone:
* Email:
* Email (confirm):
* Sales Force Size:
* Required field

Primary Attendee Information

Same as billing information

* Name:
Title:
Company:
* Email:

Additional Attendee Information

	Attendee 1
* Name:
Title:
Company:
* Email:

	Attendee 2
Name:
Title:
Company:
Email:

* Would you like to register a role-playing coach? Yes No

Note:
Because you have selected to register someone as a role-playing coach, you cannot pay on-line because we have to verify that the selected individual is qualified to be a role-playing coach. Please call 800.993.1228 (in the USA), or 617.848.8584 (international) if you have any questions about this.
Please understand that you can still register on-line, but your only option will be for us to invoice you."

Payment Information

I have read and agree to the CustomerCentric Selling® policies .

* Please select the payment method:
Credit Card Invoice

* Type:
* Name on Card:
* Credit Card #:
* CCV/CCV2 #:
* Expiration Date:
Only MasterCard and Visa is accepted online. To pay by American Express or Discover, please contact us so we can manually process your payment.

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