Course Registration for Advanced Clinical Concepts in Lactation - 2015
Name/Title __________________________________________________________________
Preferred First Name for Name Tag ______________________________________________
Street Address __________________________________City/State/Zip _________________________
Home Phone __________________E-mail address_________________________________
____________________________________________
___________ Charlotte NC area, October 19-21, 2015
___________ Chicago IL area, November 16-18, 2015
Indicate payment enclosed:
________$435 (Early bird – postmarked up to one month prior to course start)
________$485 (Regular tuition)
Payment Information:
Check # ____________
Credit Card # ___________ ___________ __________ ___________
Expiration date ____________ Security Code (on back) __________
(Only Visa, MasterCard and Discover accepted)
Name as it appears on card ____________________________________________
Billing address if different from above (Street) ____________________________________________
City/State/Zip ___________________________________________________
Confirmation will come via e-mail from LECOffice@aol.com. Please watch for it!
Fax to: 630-260-8879 or mail to: LEC c/o Jan Barger, 618 N Wheaton Ave, Wheaton IL 60187
For questions, e-mail (as above) or phone 630-260-4847
IMPORTANT NOTE: Refunds are given upon receipt of written notice up until one month prior to start of course (8/28 or
10/16 ), less a $50 admin fee. After 14 days prior to start of course, you may find a substitute or transfer your remaining
credit to an ACCL in 2015. We are unable to refund tuition after 14 days prior to start of course for any reason. LEC
reserves the right to cancel any program if there are fewer than 22 registrants 4 weeks prior to the start of the program. In
that case, all tuition will be refunded with no processing fee.