Career Development Institute

Self Defense Training Seminar

August 22, 2008
November 7, 2008
9-5pm
Manasquan Dojo
56 Union Ave.
Manasquan, NJ 08736

Career Development Institute

PO Box 5024

Kendall Park, NJ 08824

732-821-6997 (phone)

732-821-1514 (fax)

careerdevelopment@comcast.net (email)

www.careerdevelopmentinstitute.org (website)

Self Defense Training Registration Form

Please specify training date: _____ August 22, 2008 _____ November 7, 2008

APPLICANT INFORMATION (Please type or print clearly using black ink)
LAST NAME			FIRST				MIDDLE INITIAL
HOME ADDRESS							TELEPHONE NO. ( )
CITY		STATE				ZIP CODE
APPLICANT’S EMAIL ADDRESS
EMPLOYING AGENCY				COUNTY			AGENCY TELEPHONE NO.
AGENCY MAILING ADDRESS							AGENCY EMAIL ADDRESS
CITY	STATE				ZIP CODE		AGENCY FAX NUMBER

Please return this form to the above address with training date requested and a check or purchase order payable to:

Career Development Institute in the amount of $99 which covers tuition for this seminar.