First Name         

                          Last Name         

                          Address 1          

                          Address 2          

                          City                   

                          State                  select your state ** Outside of US ** Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

                          Zip/Postal Zone

                          Country             

                          Email                

                          Event Name      

To reserve your place in the class, group, or workshop, please send a deposit or full fee for the event. Your payment is fully refundable up to two days before the start date. You may pay by credit card, check, or money order.

To pay by check or money order: Please submit this completed registration form, and then send a check or money order payable to: Michael Nagel LLC. Send your check or money order to:

To pay by credit card or PayPal: I accept Visa, MasterCard, American Express, Discover, eCheck, and Paypal.

You may pay by credit card or PayPal either online or by phone.

To pay online by credit card or PayPal, please submit this completed registration form. You will receive a Thank You acknowlegement page for your registration. That page provides instructions for how you may proceed to pay by credit card or Paypal.

To pay by telephone, please submit this completed registration form, and call me with your credit card billing information. I will want to know your credit card number, its expiration date, your name as it appears on the card, and the credit card billing address.

Of course you may make other arrangements with Michael regarding payment of your deposit or event fee.

Please indicate below the method by which you are paying.

                          Sending Check or Money Order                 

                          Paying online by credit card or PayPal      

                          Calling with Billing Info                             

                          Making other arrangements with you