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Enrollment Form Date: ________________ Name: _______________________________________________ Organization: __________________________________________ Contact Number: ____________________________ Early enrollment pricing listed below. Call for group discounts. Getting, Keeping and Deserving Your Customers , , , _______ Enrollments x $ = $ ____________ The Art of Presentations , , , _______ Enrollments x $ = $ ____________ - or - For BOTH classes _______ Enrollments x $ = $ ____________ TOTAL: $ ____________ ___ Mastercard ___ Visa ___ American Express Full name on card: __________________________________________ Card Number: _______________________________ Exp ___________ Signature: _____________________________________ Fax or mail this statement in with credit card information or check payable to: Hackmann Enterprises c/o Fax Tickets will be mailed to the address you provided on the same day that payment is received. For any questions, please send email to dhackmann@hackmann-enterprises.com or call . Refunds available until Sponsored by the Classes held at the

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