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Copyright © 2002, 
Consultants Extraordinaire
All rights reserved.
Revised: Wednesday February 10, 2010


 

 


Simply print this page, fill in the requested information, fax the form to: (818) 362-3181, or mail-in the form.
Personal Information 
Name:_____________________________________________
Address:___________________________________________
City:____________________ State:______ Zip:__________
Telephone Number: _______________________
Fax Number: _________________________
Email Address: ________________________________
Class Information
Name of Class: _____________________________________
Date of Class: __________________
Class Location: _____________________________________
Payment Information
MasterCard, Visa, or Discover
 

Card Number: ______________________________________

Last 3 digits on back of card      _____________

Exp. Date: _________ Amount Charged $_______________
I authorize Consultants Extraordinaire to charge my card for
this class.
Signature:
_________________________________________

The charge will posted on your monthly statement as: Consultants Extraordinaire

Mailing Address for Checks
Consultants Extraordinaire
12501 Rajah St.
Sylmar, CA 91342

 

 

Contact Information
Consultants Extraordinaire
12501 Rajah St.
Sylmar, CA 91342
Phone: 800 517-6101
Fax: 818 362-3181
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