Course Title:  * required Date of Course:  * required Attendee Names: Company:  * required

Contact Name:  * required Phone Number:  * required Fax Number: Email Address:  * required Address:  * required City, State & Zip:  * required Payment Method (Pick One): Purchase Order Number Credit Card Check

P.O. Number (If applicable): Charge to (If applicable): N/A Visa Master Card American Express Card Number: Name on Card: Expiration Date on Card: Do you need a hotel room? N/A Yes No Hotel charges can be added to your training invoice.  Would you like to do this? N/A Yes No

Prepay with Check Number (If applicable): Motion Salesperson: Branch Location: Total Course Fees (See our pricing chart below.):  * required If you are unable to attend a class for which you are scheduled and cannot send a substitute, we will gladly refund your fee, if you cancel at least two weeks prior to the class date.  If you cancel with fewer than two weeks notice, you will be invoiced and allowed to attend a future Motion institute course of comparable value.