| * First Name: |
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| * Last Name: |
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| * Agency: |
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| * Street Address: |
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| * City: |
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| * State: |
* Zip:
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| * Phone: |
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| Fax:
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| * E-Mail: |
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| * Spouse Attending? |
Yes
No |
Spouse
Name if Attending: |
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Additional Information |
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If
You have you attended a Seminar before, please let us know
where and when: |
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|
Which Are You?
|
| CSRS:
|
CSRS- Most Federal employees hired prior to 1984 are
covered by CSRS. This includes employees who did not elect FERS
coverage and who have no breaks in service since 1984. |
| CSRS-Offset:
|
CSRS-Offset - Generally, covers employees rehired after
12/31/83 with more than a one-year break in service and at least
five years creditable civilian service by the end of 1986. |
| FERS:
|
FERS - Generally, all employees first hired after 12/31/83
were automatically subject to FERS on 1/1/87, unless their appointments
were temporary or intermittent. No employee first hired after
12/31/86 may have CSRS coverage. |
| TransFERS:
|
TransFERS - CSRS employees had an opportunity to transfer
to FERS during two open seasons (7-1-87/6-30-88 and 7-198/12-31-98).
Also, employees rehired after 12/31/83 who are not automatically
covered by FERS, and who have a service break of four or more
days, may elect to transfer to FERS within 6 months of being
rehired (unless temporary or intermittent appointment). |
| Other:
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Payment Information
PBS accepts VISA, MasterCard, Discover and American Express
(If
you are paying with a Training
Voucher, you MUST pay for your
spouse separately
with a credit card. See Below.)
*Credit cards are not processed until closer to the seminar
date.
*Price of seminar does not include lodging
Please Mail Copy to:
Personal Benefit Services of Colorado
4875 Ward Road, Suite 100
Wheat Ridge, CO 80033
Or
Fax to 303-420-8082
|
* Form of Payment:
Check all that apply
|
Training Form/Document
DD1556/SF182 (Please Mail Copy) |
| Government Credit Card
(Please provide
CC information below) |
| |
Personal Credit Card
(Please provide
CC information below) |
Discount
Coupon Code:
|
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| |
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| |
PBS Federal ID:
06-1650807
|
| |
Government Credit Card Information
Cost: $550.00
per attendee*($100.00 additional for spouses)
*Discounts
for multiple attendees from the same office:
5-9 attendees: $30.00 off each participant's tuition
10+ attendees: $75.00 off each participant's tuition |
Total
Number of People Registering on Government Credit Card: |
|
| Total
Amount Charged $ |
Make
sure to figure in discount if more than 5 people |
| Account
Number: |
|
| Expiration
Month |
Year
|
| Card
Verification Number : |
What
is Card Verification ? |
| Name on Card: |
|
| Email
Address of
Credit Card Holder: |
|
Billing Zip
Code of credit card: |
|
| |
|
| |
Personal Credit Card
Information
Cost: $550.00
per attendee*($100.00 additional for spouses)
*Discounts
for multiple attendees from the same office:
5-9 attendees: $30.00 off each participant's tuition
10+ attendees: $75.00 off each participant's tuition |
Total
Number of People Registering on Personal Credit Card: |
|
| Total
Amount Charged $ |
Make
sure to figure in discount if more than 5 people |
| Account
Number: |
|
| Expiration
Month |
Year
|
| Card
Verification Number : |
What
is Card Verification ? |
| Name
on Card: |
|
| Email
Address of
Credit Card Holder: |
|
Billing Zip
Code of credit card: |
|
| |
Persons interested
in enrolling via phone are welcome to call us at: 1-800-892-2632 |
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|
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Cancellation
Policy
Refunds
will be possessed as follows: |
| Cancellations
must be requested in writing 30 days prior
to the seminar to receive a full refund. If a cancellation
is made in writing between 20 and 30 days prior to the seminar,
you will be assessed a $75 fee. Cancellations made 20 days or
less prior to the seminar date will be assessed the full cost. |