Enroll me in the Fundamentals of Dyslexia Correction Workshop on:

Payment Options

Credit Card

I will be using a School District Purchase Order number:

Please bill me via direct mail, I will send a check by:

Please invoice to the following address:

$1175 ($1075 60-day advance payment in full)

OR

$200 deposit ($975 balance* due upon attendance; *$925 balance due for DDAI members or group members)

For group rate, note other group member(s)/organization

Make check or purchase orders payable to DDAI

Credit Card:

Visa Mastercard Amex Discover

Number   

V-Code  

Expiration Date:

Card Holder name and address:

Reciept/Confirmation

Send my receipt and confirmation to:

Name:

Business:

Address:

Day Phone: Evening

Email Address:

Comments: