Registration Form for Purchasing Recording Access

To register for a seminar, complete the form below, and select view/print or submit form. If you elect to register online, your completed form will be submitted via secure channels. If you elect to print and send this form, please fax to 615-565-3067, send by email to ACHEducation@goldleaf.com, or by mail to Goldleaf Financial Solutions, 9020 Overlook Blvd., Brentwood, TN 37027 Attention: Ginger Simpson. You will receive an e-mail confirmation once your registration is processed.
Attendee Name:	Mailing Address:
Institution Name:	City, State, Zip:
Email Address:	Phone Number:	Fax:

Session(s) Desired

Please indicate the title of the session in which you would like to receive recording access.  If you would like to purchase access to more than one recording, please indicate each session title below.
Session(s) Title:	1. 2. 3. 4. 5.
Please contact ACHEducation@goldleaf.com if you would like to purchase more than 5 recordings.

Payment Information

For questions regarding pricing, please visit www.goldleaf.com/ot_session.htm and look for the session title.
	Pricing is per login, with general sessions priced at $150 each.
	1-hour, key interest topics are periodically offered at the price of $100.
	Learning Link Packages Include:
		SUPER (4 sessions for $550) PREMIUM (6 sessions for $800) ELITE (10 sessions for $1,250)
	NOTE:  Packages are valid for up to a year from your purchase date.

COUPON CODE:

I (we) authorize Goldleaf Financial Solutions, to invoice or initiate a one-time debit entry to the account designated below as noted in the amount of $ * . Revocation of this authorization must be received in writing. Debits/credits will be processed by the first Tuesday of the month following training.

Pay by ACH Credit/Debit:

Please remember to enter all necessary information in the authorization block. Checking Account #: (or) General Ledger Account #: Financial Institution Routing & Transit #: Authorized Signature: (type in authorized name, if different than attendee name)

Pay by Invoice:
Add $25 processing fee.

If mailing address is different than the above, please fill out the below. Attention:                      Mailing Address: City, State, Zip: Total Training Amount : (add $25 processing fee)

View/Print    This option will allow you to print out the application and mail or fax to Goldleaf Financial Solutions.
Submit        Your registration will be sent to Goldleaf Financial Solutions via secure channels. By submitting this registration form, you authorize Goldleaf Financial Solutions to automatically debit the registration fee(s) from the account listed above.