Golden Study Group Registration Form

Golden Study Group

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Registration Form

Please complete the following information and

mail with your check, payable to Dr. Roni Golden.

FOR IMMEDIATE RESERVATION, CALL (732) 972-0325

Name:

Address:

Phone:

Fax:

e-mail:

Date(s)/ location program:

Amount enclosed:

Print this form and mail to:

Dr. Roni Golden

P.O. Box 31

Wickatunk NJ 07765

Tuition is refunded only if the request is received in writing 14 days prior to the program. A $25 processing fee is nonrefundable.

Rules and Regulations
The courses are designed to enhance your professional experience and offer tremendous value to you. As such, courses will start promptly, and will end according to schedule. Please make your arrangements to ensure your participation for the full day.

It is the intent of the Golden Study Group to assure that its education mission of the Continuing Education activities should not be influenced by the special interest of any individuals associated with its programs. Having an interest in or an affiliation with a corporate organization does not necessarily influence a speaker's presentation, but the relations must be made known in advance to the participants in accordance with the Standards of the AGD. Conflict of interest statements and commercial sponsorship agreements are available for review upon request.