Registration Request Form

Complete this form and make a payment to register.

Course Number Requested:
Course Date Requested:
Course Location Requested:
First Name:
Last Name:
Business Name:
Number of employees in your business:
Street Address:
City:
State:
Zip Code 5:
Zip Code 4:
Work Phone:
Home Phone:
e-Mail:
Requested domain name for class website:
Will you bring a PC laptop to class (preferred)?:
Will you bring a Mac laptop to class?:
Comments:	Comments?