TALK POWER INC.

SPEAK WITHOUT FEAR...TALK POWER PUBLIC SPEAKING TRAINING SEMINARS

TalkPower® Public Speaking Without Stress
Seminar Registration Form

To order by phone, call (800) 525-3718 / (212) 684-1711.

To order by e-mail, contact Natalie H. Rogers.

To order by mail, complete and print out the Order Form and mail it to:
TalkPower, 333 E 23rd Street, Suite 11B, New York, NY 10010-0471

Name:______________________________________________________
Address:____________________________________________________
City:_______________________________________________________
State:_____________ Zip:_____________________
Occupation:_________________________________________________
E-mail Address:______________________________________________
Home Phone:________________________________________________
Work Phone:________________________________________________

Cost: $995
Please enclose a check for $200.00 as a deposit for the Stress Seminars For Public Speaking.
The balance of $795.00 is due upon registration at the seminar.
(Please make check payable to TalkPower, Inc.)

Payment Type:
[  ] VISA     [  ] MASTER CARD     [  ] AMERICAN EXPRESS
Credit Card Number:__________________________________________
Expiration Date:_____________________________________________
Name on Card:______________________________________________
Signature:__________________________________________________

Where did you hear about us?
[  ] NY Magazine [  ] Women's Bar News
[  ] Wall St. Journal [  ] Family Therapy Networker
[  ] Common Boundaries [  ] Personal Reference
[  ] Other:___________________________________________________

TalkPower®
Telephone: (800) 525-3718 or (212) 684-1711
Fax: (646) 349- 4720
Mailing Address: 333 E. 23rd Street, New York, NY 10010-0471

©2002 TalkPower Inc.