AeA Silicon Valley/Northern California Council
Group Rate Registration Form

Event:  Coaching for High Performance & Development
Date:   Tuesday, June 3, 2008

FOUR EASY WAYS TO REGISTER:

• MAIL: Print out this form and mail to Colette Gonsalves at AeA Silicon Valley/Northern California Council, 5201 Great America Pkwy, Ste. 400, Santa Clara, CA 95054
• FAX: Print out this form and fax to Colette at 408.987.4298.
• E-MAIL Colette Gonsalves.  Please include the title and date of the event you are registering for as well your name, title, company, email and phone.  Please do not send credit card information via email. You will be contacted for payment information.
• CALL Colette at 408.987.4248.

Your registration is not confirmed until full payment is received.

REGISTRATION:  

Group Rate: Early bird pricing - Register by Friday, May 2nd and SAVE!
AeA members = $250
Non-AeA Members = $330

Group Rate: Regular pricing - Registrations received on or after May 5th
AeA members  = $270
Non-AeA Members  = $350

Please attach a list with the full names, titles, and email addresses of all registrants.

Name(s):______________________________________________________________________

Company: ____________________________________________________________________

Title(s): _______________________________________________________________________

Address: _____________________________________________________________________

Phone: _______________ Fax: _______________ E-mail: _____________________________

Payment Information
Check (payable to AeA)      VISA       MC         AMEX

Card Number: ____________________________________________  Exp date: ____________

Cardholder name: _______________________________________________________________

Verification code (last 3 digits on back of credit card)

This page was last updated on 07/31/06.  
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