CPT Mail-in Registration Form


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	Last Name



		First Name



	M.I.

		Address


		City




	State



	Zip Code

Daytime Phone #

E-mail Address


	$399 Standard rate

Card Number

Exp. Date


	$99 ATSA Membership


	NOTE: Billing address must be same as above address

Name as it appears on card

Address (If different from above)



	City



	State



	Zip Code


	SIGNATURE________________________________________________________

After filling out the form, please click the print icon on your web browser or
CTL + P on your keyboard to print the form. If you are paying with check or money order, mail the check and form to:
                             American Training & Seminar Association
                             National Resource & Training Services.
                             P.O Box 1003
                             Cleveland, TN 37364-1003
If you are paying by credit card, please mail or fax the form to (423) 559-1584. If you don't have a printer, please call us toll free at 1-866-572-0142 and our staff will be glad to take care of you. And, of course, you can always register instantly, online by clicking here.