User Group Workshop Registration Form


2007 Ortivus North America Software Users Group Workshop Registration Form

Please provide the following attendee information (submit one form per person, please):

To register, complete the following form and click the "Submit" button at the bottom of the form.
* Indicates a required field.

Attendee Information

*First Name:

*Last Name:

Title:

*Company:

Customer ID:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*E-mail:

*Phone:

Fax:

User Group Workshop Information

Please Select Your User Group Workshop Choice:

Hands-on Style -- Denver, Colorado - November 7-9, 2007

Novice Track (For participants with less than a year of experience with Sweet-Billing)

Advanced Track (For participants with more than a year of experience with Sweet-Billing)

Please Indicate Your User Group Workshop Fee Information:

Hands-on Style -- $800.00

Less early-bird or holiday discount* (-$50.00)

Early Bird Dates: TBA

Less corporate discount** (-$25.00)

Grand Total:

*To be eligible for the early-bird discount, you must register by the early-bird date specified for the workshop you wish to attend. Holiday discount can also be used, but not in conjunction with the early-bird discount.

**Corporate discounts of $25.00 per person are available when three or more people from the same service/company register for the same user group workshop.

Please Indicate Your Payment Choice:

Please invoice me at the address above:

Fax in a printed online registration form to Bernice Holthaus (confidential fax # 563-387-3198).

I wish to charge the payment to my credit card:

Registrant must call Ortivus NA (800-537-3927, ext. #221) to charge the payment to the appropriate credit card (Master Card, Visa, American Express or Discover cards accepted)

What software topic(s) would you like covered at the User Group?

{enter your reponse here, 255 characters or less}

NOTE: If minimum sign-up numbers are not met within 30 days prior to event, the User Group Workshop may be canceled. Please check the Ortivus North America web site 30 days prior to the User Group Workshop you plan to attend to ensure the event will take place before booking your plane tickets.
CANCELLATION AND PAYMENT POLICIES: All cancellations must be made in writing and mailed to Ortivus North America. Cancellations received at least 30 days before the registered User Group Workshop date will receive a full refund. Cancellations received less than 30 days before the registered User Group Workshop date will receive credit for the registered amount toward your next seminar, User Group Workshop, training or Ortivus North America purchase. Faculty, speakers and course material are subject to change without notice.
OTHER ARRANGEMENTS: Transportation, hotel, food, entertainment and parking charges are not included in your registration cost. Each service is responsible for making its own hotel arrangements. Please call the specified hotel for your registered location to receive reservations information before the group cut-off date, which usually precedes the User Group Workshop date by two weeks. Be sure to mention Ortivus North America to receive the discounted group rate.

Ortivus, Inc.

800-537-3927

FAX: 563-387-9333