The document is a seminar registration form that collects information from participants and their organizations. It requests the seminar details, company and participant contact information, payment options, and terms regarding cancellations and refunds. Registration confirmations are sent via email upon completion of the form.

1. Seminar Registration Form
Course Title
Location
Date(s)
Time(s)
Course Fee
Course Number
Complete the registration form - all information is required. Registration confirmations are sent to participants via email.
Company Name: __________________________________________________________________
Company Contact Name: ________________________________________________________ Payment Options:
Title: _______________________________________________________________________________ ___ Check Enclosed
Authorizing Signature: __________________________________________________________
___ Invoice Organization
Company Address: _______________________________________________________________
___ Purchase Order # _____________
City, State, Zip: ____________________________________________________________________
___ Credit Card (MC, AMEX, Discover, VISA*)
Contact Phone Number: _________________________________________________________
To protect credit card privacy, call
Contact Email Address: __________________________________________________________ (920) 735-4798 for credit card
transactions. A 2.75% non-refundable
Participant Name: ______________________________________________________ service fee applies.
Title: _____________________________________________________________________
*VISA company cards only
Address (if different than above): _______________________________________________
Email: ____________________________________________________________________
DOB: _____________________________________________________________________
Participant Name: _______________________________________________________
Title: ______________________________________________________________________
Address (if different than above): ________________________________________________
Email: _____________________________________________________________________
DOB: ______________________________________________________________________
Registration Contact: Emily DeMoulin
E: demoulin@fvtc.edu P: (920) 735-4798 F: (920) 735-4771
Terms of Multiple Recipient Agreement: This agreement involves services provided by FVTC to participants from several organizations (Multiple Service Recipients) all participating in
the same service. As a participant, it is the understanding of the above signed that he/she/they will receive the services stated above. The financial obligation for this addendum is the
responsibility of the organization listed on the multiple recipient agreement and registration form.
Cancellations/Refunds: Cancellations must be received at least five business days prior to the course start date for refunds. Substitutions and transfers are accepted with prior notice
and approval. Fees will be refunded in full, less applicable service fees on credit card payments, if course is cancelled for any reason.