paxUnited

PMUI Fed ID 75-2667406

PeaceKeepers Course Registration Form

Check appropriate date:

___Dallas-June 3-5 ___San Antonio-July 15-17 ___Dallas-July 22-24 ___El Paso-Aug. 3-5

Please check which materials you are ordering. One set is needed per campus trained.

$225

Course Teacher's Manual and video

$125

Site license- student workbook

$250

Registration Fee for Participants not from Texas

Registration/Billing/Contact Information

Name

Position

School/Organization

Mailing Address

City

State

Zip

Billing Contact Person

Position/Title

Phone

Fax

Payment Method

Check enclosed # _____________________

Purchase Order enclosed #___________________

Money Order #________________

Please make check or PO payable to paxUnited, and forward it with the registration

form via mail to:

paxUnited

c/o Darlene Allen

2093 North Collins Blvd, Ste 101

Richardson, TX 75080

for billing questions contact Darlene Allen, 1-800-650-5247

Purchase Orders may be faxed to: 972-671-9549

At all sites except San Antonio, the training times are 8:30 am-4:30 pm each day

San Antonio training time is 9:00 am-5:00 pm each day

The training is free: Register as many as you want from your campus

Questions?

Contact Debbie.Womack@paxunited.org or Darby.Huber@paxunited.org or phone 800-6