PIO Boot Camp - Registration Form

Name ______________________________ Rank ___________

Agency/Dept. ____________________________________

Address ________________________________________ Suite ___________

City, State, Zip ___________________________________________________

Telephone _______________________ Fax ___________________________

E-mail address __________________________________________________

Payment must be made prior to seminar - Please send P.O. with registration

Payment Amt. $_______ Check # ______ Purchase order # ______________

I agree to pay above total amount.

Signature:___________________________________ Date __________________

Payment must be made before the start of the seminar unless other arrangements have been made with us. Cancellation does not affect the registrant's financial responsibility unless we receive notice 15 days prior to the start of the PIO Boot Camp. This copyrighted course contains exclusive confidential material developed by Chris Ryan and Ryan & Assoc. Public Relations. Audio taping, video taping and/or recording by any other means other than that done by the presenter in conjunction with the course is strictly prohibited. Thank you for your cooperation.