Training Registration Form
Please complete the responses below to register for your selected training course.

*By completing this form, you authorize LaSorsa & Associates to accept full payment of the course registration fee.
*Payment must be made in full in order to complete the registration.
*No refunds once confirmed – you may request to attend another course at a later date within 12 months.
*If a hotel package is selected and registration confirmed, deferring to another course date may add additional costs/fees.

Email address *
Select Course: *
Course Location *
Your answer
Course Dates *
I.E. 10/20-28/2018
Your answer
Last Name *
Your answer
First Name *
Your answer
Phone (Mobile) *
I.E. 123-123-1234
Your answer
Male or Female *
Company Name
Your company's name or your employer
Your answer
Facebook URL
Your answer
LinkedIn URL
Your answer
The exact Name you want on your certificate *
Your answer
Referred from? *
Required
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Payment Method *
-PayPal, Credit Card, Debit Card: Complete this form and then use the link which will be provided. If by Check: submit this form and we will contact you for further instructions.
A copy of your responses will be emailed to the address you provided.
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