THIS PROGRAM IS SOLD OUT - Completing this form will put you on the waitlist ONLY

Prosci® Change Management Certification Program Registration Form

Complete the form below OR print this PDF and email to to 970-669-7005 to get your registration started.

Course Information

Date of Class:  December 5-7th, 2016                                             Program Tuition:  $2400 per individual

Program Location: Cisco Systems, Inc. - San Jose Campus Building 9 260 East Tasman Dr. San Jose, CA 95134

Important Details

  • When your participation is confirmed, you will receive a welcome email providing details of the course and location.
  • You must be a member of the ACMP NorCal Chapter in order to register and attend this program.
  • You will need to make your own travel arrangements and lodging, if needed.


  • After completing the form below or emailing/faxing, please call 970-203-9332 to provide Credit Card payment
Name (as you would like it to appear on your certifcate) *
Name (as you would like it to appear on your certifcate)
Is your organization tax exempt?

Cancellation policy: specific to Prosci program tuition. More than 20 calendar days before the program, tuition is fully refundable. Within 20 calendar days or less of the program start date, tuition is nonrefundable. All cancellation/transfer requests must be received in writing (send via email to