Davis Learning Strategies
2010-2011 DLS Workshop Registration Form
Register early! Seating is limited.
Must register at least 15 days prior to workshop date. Late registrations add 10% to total cost.
Enroll me in the following Davis Learning Strategies® 2-day Workshop:
Location:__________________________________________________________
Date:______________________________________________________________
Enclosed is my payment of
¨$495 early registration --60-day advanced
¨ $595 payable to DDAI: (all prices in US Dollars
check ¨ credit card ¨ School District Purchase Order:#______________
Credit Card: ¨ Visa ¨ MasterCard ¨ Amex ¨ Discover
(Please Print Clearly)
Number ________-_________-________-_______ Exp Date:_______Vcode:______
Name as it appears on card ___________
Signature:_____________________________________________________________
Send my receipt, advance study materials and confirmation to:
Name__________________________________________________________________
Address_____________________________________City:______________________
State/Province/Country___________________________Zip code_____________
Phone: (____)___________________Alternate phone: (____)__________________
E-mail: ________________________________________________________________
School/District :____________ ______________________grade taught:________
Cancellation and Refund Policy: All payments are fully transferable to alternate workshop dates. A $65 administrative fee is deducted from all refund requests. Workshops may be subject to cancellation if minimum enrollment requirements are not met, in which case, a full refund will be made.