Directions: Print this form and fill it out (please print clearly) and mail with your payment to Hollywood Animals 4103 Holly Knoll Dr. Los Angeles CA 90027. Or FAX to: 323-665-9200 Upon receipt of your registration, we will send you a package with all the information.

Name ________________________________________________________________________
Address ___________________________________________________________________
City ______________________________________ State __________ Zip _______________
Hm Tel _________________________ Wk Tel _______________________ Cell/Pager _____________________
Fax _____________________________ Email __________________________________________
Seminar Date ____________________

Payment in full is required to reserve your space
___

Person @ $100.00 (For 1 person)
$ ________
___

2 People @ $95.00/each
$ ________
___

Animal & Training Manual @ $ 32.50 (Optional)
$ ________
___

Gift Card or Gift Certificate @ $ 15.00/each (Optional)
$ ________
___

Seminar Completion Certificates @ $ 25.00/per person (Optional)
$ ________

Total
$ _______

Name(s) on Certificate: If ordered

1

 ____________________________________________________________________________

2

 ____________________________________________________________________________

Payment

I wish to pay by Visa ___ MasterCard ___ Check ____ Amount to Charge $___________

Name as it appears on credit card

_____________________________________

Billing Address

 _______________________________________________________ Same as above ___
City ________________________ State __ Zip ___
Credit Card No. _________________________________ Exp.Date ____   CSV ____

I understand and agree to have my credit card charged for services / products contracted with Hollywood Animals. I promise to pay subject to and in accordance with the agreement governing the use of such card. I certify that all the above information is accurate and true and I am over the age of 18.

Signature _________________________________ Date _______