VOICE OF THE CUSTOMER TRAINING COURSE
REGISTRATION FORM

November 9-10, 2010
Omni Chicago Hotel
Chicago, IL

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 $1,595
Early registration fee (registered and paid
by October 18, 2010)		 $1,395
Group registration fee for three or more
participants		 $1,495 per participant
Early group registration fee for three or
more participants (registered and paid
by October 18, 2010)		 $1,295 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 book a room at the Omni Chicago Hotel at the special rate of $199 per night, please call the hotel at 1-800-843-6664 by Monday, October 18, 2010. For more information, please call Laurel Ackerman, Director of Marketing, at (781) 250-6316 or lackerman@ams-inc.com. Applied Marketing Science reserves the right to cancel this course in the event of low enrollment.