VOICE OF THE CUSTOMER TRAINING COURSE
REGISTRATION FORM

April 4-5, 2012
Loews Atlanta Hotel
Atlanta, GA

Registrant 1
Salutation: Mr. Ms. Dr.
First Name: Last Name:
Title:
Company:
Address:
City: State: Zip:
Phone: Email:
Registrant 2
Salutation: Mr. Ms. Dr.
First Name: Last Name:
Title:
Company:
Address:
City: State: Zip:
Phone: Email:
Registrant 3
Salutation: Mr. Ms. Dr.
First Name: Last Name:
Title:
Company:
Address:
City: State: Zip:
Phone: Email:
Payment Information
Course registration fee $1,795
Early registration fee (registered and paid
by March 15, 2012)		 $1,595
Group registration fee for three or more
participants		 $1,695 per participant
Early group registration fee for three or
more participants (registered and paid
by March 15, 2012)		 $1,495 per participant
Total number of attendees:

Total payment due to AMS: $
 Please send an invoice to the above address
Check payable to Applied Marketing Science
is enclosed
Pay by credit card. Please contact me for
credit card information.
Payment in full is required prior to course participation. Course refunds will be permitted if notified in writing of cancellation at least 30 business days prior to the event. A 50% refund will be given if notified of cancellation between 10 and 30 business days before the event. Within 10 days, no refunds will be issued. Substitutions are allowed at any time. To make your room reservation or find out more information about guest accommodations, please contact the Loews Atlanta Hotel reservation line at (888) 563-9736 or visit their website at http://www.loewshotels.com/en/Atlanta-Hotel/accommodations. For more information, please call Holly Senykoff at (781) 250-6332 or hsenykoff@ams-inc.com. Applied Marketing Science reserves the right to cancel this course in the event of low enrollment.