The Private Practice Model

Working for Yourself, Designing Your Own Destiny

Web-PPMLogo.png

 

Register below for upcoming seminars!

 

The Private Practice Model is returning to the New York area for the first time in three years. Join us on Dec. 5 at the Penn Club in New York, New York, or on Dec. 6 at the Hilton Garden Inn in Nanuet, New York. Seating is limited. Call Kelly Price now at 732-254-0300 to reserve your seat. Just complete and submit this form. Or, if you prefer, print and FAX this form to (732) 254-3131.

The fields marked with (*) are required fields.

*

What type of credit card are you using?
 * required

*

Address Line 1
 * required

*

Please enter your full name as it appears on your credit card.
 * required

*

Enter the billing address for your credit card
 * required

*

City
 * required

*

State
 * required

*

Zip Postal Code
 * required

*

Country

*

Telephone Number
 * required

*

Email Address
 * required

*

Enter the type of card you're using: Mastercard, Visa, Discover, etc.

*

Enter your credit card number

*

Enter the expiration date of your credit card:

*

Tell us which seminar you wish to attend: Dec. 5 at the Penn Club in New York, New York, or Dec. 6 at the Hilton Garden Inn in Nanuet, New York.
 
Your Comments