Page 1 of 5

Summit Workshop Registration

  1.  

    To register for our Summit Workshop Program, please fill out the following multi-page form in its entirety. If you wish to register by phone, call (949) 759-1928. To find out more about the Summit Workshop Program and how it can help you and your company excel in the areas of management and leadership please click HERE!

     

    NOTE: A (*) shown after a question or field indicates that question or field is required to be filled with the corresponding information.

     

    RELATIONSHIP

    		EXAMPLE

    Administrative Contact =

    This is the primary person responsible for entering the data into this form.  This can be an office administrator, secretary or the actual Participant or Supervising Manager

    Participant =

    Individual for which the Survey is about

    Supervising Manager =

    The Individual for whom the Participant report to

  2. Workshop Dates & Places:

  3. Choose A Summit Workshop Date and Location:(*)
    Invalid Input
  4.  

  1. Workshop Participant Information:

    HINT: Participant =Individual for which the Survey is about

  2. Full Name(*)
    Please Type The Participants Full Name
  3. Title
    Please Type The Participants Title
  4. Company(*)
    Please Type The Supervisors Company Name
  5. Address 1(*)
    Please Type The Participants Address
  6. Address 2
    Invalid Input
  7. City(*)
    Please Type The Participants City
  8. State(*)
    Please Type The Participants State
  9. Zip Code(*)
    Please Type The Participants Zip Code
  10. Email Address(*)
    Please Type The Participants Email Address
  11. Phone(*)
    Please Type The Participants Phone Number
  12. Ext.
    Please Type Participants Extension
  13. Fax
    Please Type Participants Fax Number
  14.  

  1. Supervisor Information:

    HINT: Supervising Manager - The individual for whom the Paticipant reports to

  2. Full Name(*)
    Please Type The Supervisors Full Name
  3. Title
    Please Type The Supervisors Title
  4. Company(*)
    Please Type The Participants Company Name
  5. Address 1(*)
    Please Type The Supervisors Address
  6. Address 2
    Invalid Input
  7. City(*)
    Please Type The Participants City
  8. State(*)
    Please Type The Supervisors State
  9. Zip Code(*)
    Please Type The Supervisors Zip Code
  10. Email Address(*)
    Please Type The Supervisors Email Address
  11. Phone(*)
    Please Type The Supervisors Phone Number
  12. Ext.
    Please Type Participants Extension
  13. Fax
    Please Type Supervisors Fax Number
  14.  

  1. Administrative Point of Contact Information: (if you are not the workshop participant)

    HINT: Administrative Point of Contact = This is the primary person responsible for entering the data into this form.  This can be an office administrator, secretary or the actual Participant or Supervising Manager

  2. Full Name(*)
    Please Type The Administrative contacts Full Name
  3. Title
    Please Type The Participants Title
  4. Company(*)
    Please Type The Administrative contacts Company Name
  5. Address 1(*)
    Please Type The Administrative contacts Address
  6. Address 2
    Invalid Input
  7. City(*)
    Please Type The Administrative contacts City
  8. State(*)
    Please Type The Administrative contacts State
  9. Zip Code(*)
    Please Type The Administrative contacts Zip Code
  10. Email Address(*)
    Please Type The Administrative contacts Email Address
  11. Phone(*)
    Please Type The Administrative contacts Phone Number
  12. Ext.
    Please Type Participants Extension
  13. Fax
    Please Type Participants Fax Number
  14.  

  1. Billing Information:

    HINT: Billing Contact = The individual responsible for approving and processing the bills for payment

  2. Full Name(*)
    Please Type The Billing Contacts Full Name
  3. Title
    Please Type The Participants Title
  4. Company(*)
    Please Type The Billing Contacts Company Name
  5. Address 1(*)
    Please Type The Billing Contacts Address
  6. Address 2
    Invalid Input
  7. City(*)
    Please Type The Billing Contacts City
  8. State(*)
    Please Type The Billing Contacts State
  9. Zip Code(*)
    Please Type The Billing Contacts Zip Code
  10. Email Address(*)
    Please Type The Billing Contacts Email Address
  11. Phone(*)
    Please Type The Billing Contacts Phone Number
  12. Ext.
    Please Type Participants Extension
  13. Fax
    Please Type Participants Fax Number
  14. Registration Code
    Invalid Input
    If given a registration code please enter it here!
  15. Click to Submit Your Request
      

Home | About | Programs | Resources | FAQ | Careers | Contact Us | Workshop Registration | Privacy | Sitemap

Copyright © 2011 Performex, LLC. All Rights Reserved.

Designed by Atlanta Technology Force, Inc..