Student Registration

Chameleon Academy of Communication and Civility Registration/Contract Form

Date

Company Name

Name of company or organization

Class Type

Preferred Class Date(s)

Date

Classes Preferred

List the class you are interested in

Training Start Time

Training End Time

Preferred Class Location

At Chameleon AcademyOff-site (Another location)

Max Number of Class Participants

For groups only

Contact Name

Last

First

City

State

Zip Code

Phone Number

Email Address

Fax Number

Location Address (If Off-Site Location is Chosen)

Street Address

Street Address Line 2

City

State

Zip Code

Chameleon Academy of Communication and Civility Contract cont.

Emergency Contact 1 (For individual registration for children and adolescents only)

Last Name

First Name

Primary Phone Number

Secondary Phone Number

Please list any food allergies

Complete this for dining etiquette classes only where Chameleon provides food

Room Set Up

Please describe the set up of the room

Speaker Fees: Please ask for an email quote prior to completing this amount. A deposit of 50% of the speaking fee is due with the submission of this signed contract. The remaining balance is due 48 hours prior to the beginning of the training.

Total Speaker Fees

Trainer name

Secondary Phone Number

Travel fee amount agreed upon(a quote of travel fees will be provided to you via email. This amount must be paid in advance by the company prior to the arrival of the presenter).

Please list any additional details for the training in this box.

Please sign the contract below. This contract is void if not signed and returned with a deposit of 50% within 48 hours of the available date being confirmed. Dates can only be held with deposit.

Media Interviews may be granted prior to or at the conclusion of the presentation. Photographs may be taken during the presentation, however, audio and video recording of presentation is prohibited.

Contract addendum language (Add any language required by your company or organization)

Please sign the contract below. This contract will be voided if not signed and returned with a deposit of 50% within 7 days of the receipt of contract invoice. Dates can only be held with a deposit. Media interviews may be granted prior to or at the conclusion of the presentation. Photographs may be taken during the presentation, however, audio and video recording of presentation is prohibited.

Signature