Seminar Registration Form

Name: __________________________________________

Address: ________________________________________

City:___________________________ State: ____________

Zip: ______________       Phone: _____________________

Office Phone: _______________    Fax: ________________

Email address: ___________________________________

SSN# _____________________    Date of Seminar: _____________

Name of Seminar/Program: ________________________________

Location of Seminar: ______________________________________

Degree/Certification/License (circle all that apply)
MT, PT, PTA, OT, OTA, AT, RN, LPN, DC, DDS, DMD, OD, MD

Billing Information

Circle payment method:       check    or    credit card

Circle type of Credit Card:
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Card Number: __________________________   Exp: ____________

Name on Card: __________________________________________

Signature: ______________________________________________

Enter any additional comments below:

Thank you for your registration !

Skye Breeze Solutions makes every attempt to ensure CE credit or license renewal credit will be granted by each state by gaining state approval prior to the seminar date. We do not guarantee any state will accept our courses for continuing education or license renewal. If a state is not mentioned in the Skye Breeze Solutions literature as accepting CE credits, and a participant is attending our seminar in order to meet their states CE or license renewal credits required, then the participant is required to verify approval with their state. Prior to the date a seminar is scheduled to begin, upon request, if a potential participant submits a particular state for approval, Skye Breeze Solutions may attempt to obtain CE or license renewal approval in that particular state. Approval of our seminars is pending with the NCBTMB (provider number pending).

All participants must sign In and Out for verification purposes and to receive a certificate of completion. Seminar registrations will be accepted through mail, phone or online for up to 5 days prior to the date of the seminar. On-site registration may be permitted if space allows, however, a seat is only reserved if the participant has pre-registered. Event location may change or cancel due to weather and/or lack of attendance without notice. Only those who are pre-registered will be notified in advance. Refunds are only granted if we must cancel a seminar. Skye Breeze Solutions is not responsible for registrants expenses should any program changes occur. No refunds of money or credit are given if the registrant cancels. If a registrant must cancel, they are permitted to transfer their registration charges to another Skye Breeze Solutions seminar in the same calendar year. Skye Breeze Solutions, LLC, is not responsible for any injuries or lost items at any seminar or its location.

By submitting a registration form you have read & agreed to the following Seminar Terms & Policies listed in this web site.