Print and Fax this form to 866.817.3561 OR copy & paste into email to pev@vennegroup.com                                                             Name_______________________________________________Degree_______________ Address__________________________________________________________________ City__________________________State____________Zip__________________________ email ____________________________________________________________________ Profession_________________________________________________________________ License # for CE documentation_________________________________________________ Phone (W) ______________________________(H) ________________________________ (C)____________________________________Fax________________________________ Location_______________________________Date________________________________ Registration Fee:  regular                    early (14 days prior) 1 person                        $149                       $139 2-4 people*                    $139*                     $129* 5+ people*                     $129*                     $119* *Must be submitted together to receive group rate. Amount charged______________________________ or enclosed____________________ _________Visa  ___________MC  ___________(3 digits on back of card)  _________Check Card #________________________________________________Exp Date____________ Name on card_____________________________________________________________ Signature_________________________________________________________________ CANCELLATION POLICY:  Refunds less a $25 processing fee will be given for cancellations that   are             RECEIVED in writing, in our office, two weeks or more before the workshop date.  No refunds after this time.   If a seminar cannot be held for reasons beyond the control of the sponsor (e.g. Acts of God) the registrant will receive free admission to a rescheduled seminar or a full-value voucher, good for one year for a future seminar. Non payment of full tuition may, at the sponsor’s option, result in cancellation of CE credits issued. Make checks payable to: Pamela Venné Δ The Venné Group 16 Cheltenham Way Dallas, TX  75230