Impact Training Services, Inc  > 1-800-858-6879 > >
Please complete the registration form below.  Confirmation will be sent via email within 2 business days. 

You can use one form to sign up one or more persons for multiple classes at multiple seminar locations. To do this; select the seminar name for the first class you wish to attend in the first line of the form, then select the seminar city, and class date.  Fill in the rest of the form. When you get to the "Comments or Concerns" box at the bottom of the form; type in any additional person/s you want to send to class/es, the date/s of the class/es and the seminar location/s (this way you will only have to fill out this form once) If you need help just call 800 858-6879. If we have any questions we will call you. We are here and we will receive this moments after you send this form.

Class Information
Seminar Name: seminars
Seminar City:
Date of Class: 
Attendee Information
Attendee #1:  
Attendee #2: 
Attendee #3: 
Attendee #4: 
Attendee #5: 
Company Information
Company Name:  
City:    State: Zip:  
Email Address: 
Phone #:      Ext 
Fax #:
Authorizing Manager:  
 Method of Payment
We Accept: Checks, Company POs or Credit Cards
Checks - Print this form and mail to:     
Impact Training Services, Inc.
PO Box 532
Bloomfield, KY 40008 

Company Purchase Order #       

Credit Card* *If paying by credit card add 3-1/2% to total. We will not charge your card until after the class.
Credit Card Type:  
Credit Card#:  
Security Code
Name on the Card: 
Billing Address for Credit Card Only if Different From Company Address:
City:    State: Zip:  
 *VIP code (if available): 
The VIP code can be found just to the left of the address of the person who received the brochure.

*Please Enter Any Comments or Concerns.