Morton Learning Center LLC

License Training And Continuing Education Classes

6827 North High Street, Suite #10, Worthington, Ohio 43085

Telephone: (614) 885-2800 Fax: (614) 885-2828

E-mail: mortontraining@aol.com

CLASS SIZE IS LIMITED. TO RESERVE, PLEASE SUPPLY THE FOLLOWING INFORMATION BY MAIL, FAX, OR EMAIL:

PLEASE RESERVE SPACE IN THE _____________________________

CLASS _______________________ CLASS DATE________________________

NAME: ______________________ PHONE (______) ________________

COMPANY ________________________________

ADDRESS: _____________________________________

CITY/ZIP ______________________________________

THERE IS A $50 DEPOSIT TO HOLD RESERVATION. PLEASE COMPLETE CREDIT CARD INFORMATION BELOW:

CREDIT CARD NUMBER:_______________________________________

EXPIRATION DATE: _________________

(Note: The deposit will not be charged to your account if a cancellation is received prior to class.)