Certified Training Consultant Institute Registration Form

October 15, 16 and 17, 2008.

$549.00

Please fill out the following contact information
First Name
Last Name
Title/Position
Company (if applicable)
Address Line 1
Address Line 2
City
State
Zip
E-mail address
Daytime Phone
Are you an alumnus of Ball State University?	Yes No
How did you hear about this program?

What are your areas of consulting/training expertise?

Why do you wish to enroll in the CTC Institute?


Please indicate how you would like to pay for this course.
Payment Method
Send check made payable to Ball State University, Center for Organizational Resources, Carmichael Hall Room 201, Muncie, IN 47306. If paying by credit card, we will contact youf or that number.
Are you a member of CIASTD?	Yes No

To register by phone, call (765) 285-1588 or (800) 541-9313. To register by fax, print this form and send to (765) 285-1284.