Registration Fax Form
Fax: 1-800-636-6869  or  (613) 288-0114
Name _________________________________________________________
Job Title _________________________________________________________
Organization _________________________________________________________
Address _________________________________________________________
  _________________________________________________________
City _________________________________________________________
State/Province _______________________ Country _________________________
Zip/Postal Code _______________________ Email _________________________
Phone Number _______________________ Fax _________________________

Workshops
Title Date Location Cost
       
       
       
       
(Canadian residents: Add 5% GST)
We accept the following methods of payment:

  •  Purchase Orders

  •  Money Orders

  •  Certified Checks

  •  Credit Cards (Visa, MasterCard, American Express, Discover, Diners)

    Please contact your Client Services Representative at (800) 223-2209 ext. 3000 to provide details of your payment.

  • Please Note: Due to Card Member security measures introduced by Visa and Mastercard, we require that you provide the Security Code and billing address of the credit card you are using in order to process your payment. If you have any billing questions, please feel free to contact our Accounts Receivable Department at
    (800) 223-2209 ext. 4202.

    Head Office: 6 Corvus Court, Ottawa, Ontario K2E 7Z4 Canada
    Mailing address: P.O. Box 1221, Ogdensburg, NY 13669-6221 USA
    Tel: 1-800-223-2209   Fax: 1-800-636-6869   Web: www.langevin.com   Email: training@langevin.com