SEMINAR REGISTRATION FORM Name___________________________________ Address________________________________________City____________________________________ State______________ Zip Code______________ Email_________________________________________Fax_____________________________________ Phone___________________________________ PAYMENT METHOD ( Seminars $350.00 each) Lodging must be arranged directly with Cumberland Inn. Check is enclosed______ Please charge my credit card_______ Visa_____ Master Card_____ Discover_____ American Express_____ Card Number_______________________________ Exp. Date__________________________________ Name on Card______________________________ Signature__________________________________ Please check the program(s) desired. All programs are 2 days in length and are held at The Cumberland Inn located in Williamsburg, Kentucky. Lodging may be arranged by contacting The Cumberland Inn. _____Personal Leadership Development - January 7 & 8, 2010 _____Sharpening Your People Skills - February 11 & 12, 2010 _____Team Building - March 4 & 5, 2010 _____Developing Teams With Vision - April 1 & 2, 2010 ____ Time Management - May 6 & 7, 2010 _____High Profile Customer Service - June 3 & 4, 2010 Total Order $___________ To register please print the form and fax it to 606-539-4136. Or you may mail the form to: Dr. Michael B. Colegrove Hutton Center for Leadership Studies University of the Cumberlands 7197 College Station Drive Williamsburg, KY 40769