Cornerstone Registration Form

YOU Seminars

207-34314 Marshall Road, Abbotsford  604-746-2727    Fax  604-746-2828    

Cornerstone Seminar Registration

Attendance Date __________________Today’s Date___________________________

First Name _____________________________Last Name______________________

Name you prefer to be called by_______________________(for your name tag)

Address _______________________City____________________________________

Province________ Postal Code________             Home (___)____________________

Work(____)____________    Fax (___)______________  Cell (___)________________

Best time to reach me is: ___ Daytime ___ Evening    at: ____Home ____Work ____Cell

 Email________________________________________________________________

Date of Birth________________________________        Sex   M    F

Circle One   Single             Married                   Other

Referred to YOU Seminars by_________________________________________

What do you want to accomplish by participating in this course?

1.______________________________________________________________________________________

2.______________________________________________________________________________________

3.______________________________________________________________________________________

 Are you under the care of a psychiatrist or psychologist.  Yes   No.  If you are under the care of a psychiatrist or psychologist please explain.__________________________________________________________________________________________________

Refund/ Transfer Policy Tuition is non refundable. One can transfer tuition to another Y.O.U. Seminars program up to 2 weeks before the seminar at no charge. Transfers requested within the 2 week period prior to the seminar will be subject to a $200.00 transfer fee. This policy is in effect for all courses sponsored by YOU Seminars, Y.O.U. Seminars Inc. and or Ropp Quest Inc.

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________________________________________________                                  _____/____/_____

Signature                                                                                                          Date

Payment by Cash   ________Cheque_________ Credit Card______

Credit Card Number ______________________________________

Expiry Date_____________________________________________

Amount to be charged_______________________Signature______________________