To Register, print and fill out this form, or copy/paste it into an email:

TR Seminars
Snail Mail: Tammy Roecker (TR Seminars) PO BOX 1982, Sun City, AZ 85372-1982
Phone: 602-697-6463


Please fill-out form clearly. Print in blue or black ink, and mail to above address, or
E-mail form to above e-mail address, preferred. (Fax available, call for fax number if needed.)

Name of Course: __________________________________________Date____________________

Location/Area: ____________________________________________________________________

Full Name: _______________________________________________________________________

Address: _________________________________________________________________________ City, State, Zip: ___________________________________________________________________

Phone Contacts and Type: _______________________________________________________________________________

E-Mail: _______________________________________________________________________________

Profession/s, Certifications/s: _______________________________________________________________________________

Class Registration Cost: $________.00

Payment Method:

Check: Check #_________________ (Mail to address above)

Credit Card:

Name on card: ____________________________________________________________________________

____ ____ ____ ____-____ ____ ____ ____-____ ____ ____ ____-____ ____ ____ ____ ,

Exp. ____ / ____   CVV Code_______________

Credit Card Billing Address if different from above:


City, State, Zip: ______________________________________________________________________________

By signing this form, it is acknowledged that classes may be subject to rescheduling if minimum registrations aren’t met. Your credit card will not be charged until the minimum amounts of people have registered.  Once class is confirmed, and the cards have been charged, there will be no refunds under any circumstance, but you may use the credit toward any other workshop with in a year from the original date of registration.

The above fees do not include expenses to complete the training, without limitation, food, travel and lodging.

Signed: X__________________________________________________________