Continuing Education Seminar Registration Form

1. PRINT this page & complete the information requested.
2. Payment methods accepted: Personal & business checks drawn from U.S. accounts only and made payable to: Skye Breeze Solutions for the total amount. Phone or Faxed credit card payments from Mastercard, Visa, American Express & Discover. Online credit card payments accepted through Paypal. Paypal ID: skyebreezesolutions@charter.net.
3. Mail the registration form to: Skye Breeze Solutions, P.O. Box 1651, St. Peters, MO 63376
   or Fax your registration form to: 636-627-9002. Fax line is shared - please call first 636-627-9002 when faxing.
4. We will contact you by email to confirm receipt of your registration.

Seminar Registration Form

First Name: _______________________        Middle: ____________      Last Name: _________________________

Address: __________________________________    Address 2: _______________________________________

City:_______________________________                                 State: ____________                   Zip: ______________       

Phone: ____________________                   Office Phone: __________________                 Fax: _________________

Email address: ____________________________________________

SSN#: __________________________                    Date of Seminar: _____________________________

Name of Seminar/Program(s): _________________________________             ____________________________

Location(s) 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 (enclosed- mailed forms)       check (mailed separately - faxed forms)      credit card (below)        credit card (Paypal online)

Circle type of Credit Card:

Mastercard         Visa          American Express        Discover

Card Number: _____________________________________                  Exp: _________________

Name on Card: ____________________________________                  Amount: $_____________

Billing Address & Zip: ____________________________________________________________

Signature: ______________________________________________

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.

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