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Guest Registration Form
Required fields are identified with an asterisk " * "
* Registrant Name:
* First Name:   M.I.:   * Last Name:  
* Email:  
 
 
Spouse/Guest $175 (US)/ each:
* First Name:   M.I.:   * Last Name:  
 
 
Payment Options
  • "Pay at Door" (Cash, check, or credit card accepted)
  • Check (Please make checks payable to: "LEIU Training".)
  • Credit Card (VISA, Master Card, or American Express are accepted via telephone contact.)
  • Pay Pal (After you submit this registration you will have the option to pay via "Pay Pal".)
 
 
* CAPTCHA Verification:
(Unfortuantely our site has been getting a lot of spam recently, so in an effort to minimize that we have added this CAPTCHA. Please enter both words as they appear, seperate them with a space. If you can't make out the words click the refresh icon next to the CAPTCHA to get a new set of words, or you can listen to an audio version.)
 
 
   
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    LEIU's Central Coordinating Agency     Address: 4949 Broadway Sacramento, Ca 95820     Email: leiu@doj.ca.gov     Phone Number: (800) 824-3860
    © 2005