Larimer County Sheriff's Office - Verbal Judo · Registration Form Larimer County Sheriff's Office Verbal Judo Agency Trainer Instructor Course June 25th – 29th 2018 ~ Class time:

Verbal Judo Instructor Course Registration Form Hosting Agency Larimer County Sheriff's Office

Verbal Judo Agency Trainer Instructor Course June 25th – 29th 2018 ~ Class time: 0800 to 1600

NAME (Attendee):

AGENCY ADDRESS:

ATTENDEE CONTACT PHONE:

ATTENDEE EMAIL:

NAME DEPARTMENT / AGENCY:

AGENCY NAME SPONSORING OFFICER:

BILLING CONTACT PERSON:

BILLING ADDRESS:

5 Day Instructor Course: $1495.00 per student Instructor Re-certification: $1195.00 per student (Please attach last certificate)

PAYMENT OPTIONS: Credit Card Payment: Invoice will be emailed to Billing email listed above. PayPal: Send payment via [email protected] Purchase Order: Email to [email protected]

Check: Mail to Verbal Judo, P.O. Box 222, Auburn, NY 13021

Request W-9

Should you have any questions or concerns, please contact: Pam Thompson: 1-800-448-1042 [email protected]

Thank you for continuing the legacy of Dr. Thompson's work!

BILLING CONTACT PHONE:

BILLING EMAIL:

Street City State Zip

Documents

Larimer County Sheriff's Office - Verbal Judo · Registration Form Larimer County Sheriff's Office Verbal Judo Agency Trainer Instructor Course June 25th – 29th 2018 ~ Class time: