OCCUPATIONAL TRAINING REGISTRATION

Occupational Training REGISTRATION BY EMAIL
(Registration for online classes must be done via email)	Print/Fax Registration Form
Please review our course descriptions and schedule before completing this form. (Fill in all of the blanks)
What is your name:
What is your Email address:
Please enroll me in the following course(cost in $US): (*Prerequisite must be met.)

Course start date (mm/dd/yy):
Registration Information:
What is the course attendee's name (if different from above):
Company:
Address:
city:, state: zip code:
Phone: () - fax: () -
Payment Information: All outer island courses, add ten percent. You may cancel your registration up to 14 days prior to the course for a full refund. If you cancel your registration between 14 and 7 days before the course, your registration fee will be refunded less a 10 percent enrollment charge. If you need to cancel less than 7 days prior to the course you may 1) send a substitute from your firm or 2) transfer your registration to another course of your choice offered within the next 12 months.
Credit Card Information:
Card Number: Expiration date(mm/yy):
Cardholder's name:

PLEASE NOTE: Payment is due prior to start of course. Occupational Training reserves the right to postpone or cancel any scheduled course at anytime. Last updated NOVEMBER 22, 2005.