Retreat Registration

Registration for Neuroleadership Retreat

October 17, 2008
Center for Action and Contemplation
Albuquerque, New Mexico
8:00AM to 5:00PM
with Suzanne Kryder, Ph.D.

Thank you for your interest in this retreat. The early registration fee is available until midnight on September 5th.

Repeater Discount
If you have attended a public leadership retreat with Suzanne in the past, you can register as a "Repeater" to receive a 50% discount on the fee. Under the Registration Type field below, simply check the "Repeater New Mexico resident" or "Repeater non-resident" box. The Repeater discount does not apply to people who participated in an in-house, customized retreat that Suzanne offered for your organization because the curriculum is different in the public retreats.

To register, you can either (1) complete the form below and submit it online by clicking the "Submit" button at the bottom of the form, or (2) you can print this form, fill it in, and mail or fax it to The Mind to Lead by midnight on September 5th. If you are paying by check, your registration will be complete and a space will be held for you when we receive your check by mail.

Fax:
505.883.9601

Mail:
Suzanne Kryder, Inc.
P.O. Box 35429
Albuquerque, NM 87176

Registration Form

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Business Phone*
Business Phone*

Title*
Title*

Organization Name*
Organization Name*

Billing Address*
Billing Address*

Billing City*
Billing City*

Billing State*
Billing State*

Billing Zip*
Billing Zip*

Lunch Choice*
Lunch Choice*

	Turkey and Cheese
	Ham and Cheese
	Cheese, Avocado and Tomato

Registration Type (check one)*
Registration Type (check one)*

	Participant: $349.00 + $23.56 tax = $372.56
	Repeater $174.50 + $11.78 tax = $186.28

Payment method (check one)*
Payment method (check one)*

	VISA
	MasterCard
	Discover
	American Express
	Check payable to "Suzanne Kryder, Inc."
	Purchase Order

Credit Card Number

Card Expiration Date

Card V-code (3 digits on back of card)

Signature for credit card

If you have any questions about the retreat or the registration process, click here to contact the Mind to Lead.

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