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Linux System &
Network Administration Bootcamp - Class Enrollment Form
Contact Information
Name :
______________________________________________________________________________________
(last)
(first)
(middle)
Company/Organization
:
_________________________________ Title :
_______________________________
Address :
_____________________________________________________________________________________
_____________________________________________________________________________________________
Phone : ______________________________________________________________________________________
(daytime)
(mobile/evening)
E-mail :
___________________________________________________
Linux
Background
Please circle
the
appropriate level that describes your experience/comfort level with
Linux or any other flavor of Unix.
Novice
Beginner
Intermediate
Advanced
Expert
Additional
comments:_______________________________________________________________________
Answer the following questions
if you are planning to get Linux Certification (optional):
Which
certification exam
are you planning to take? Please circle the appropriate.
LPI
Red Hat
Linux+
Other (Specify) ______________________________
Additional
comments:
_______________________________________________________________________
Class Preference
Please check the class
you will prefer to attend:
 June 14 - 15, 2008 (San Francisco - South Bay)
How did you hear about us? (optional) ___________________________________________________________
Registration Fee
Please write a
check or
money order for $1,499 ($900 without the laptop) payable to "LinuxCertified, Inc." (unless paying
by credit card), and send it with this enrollment form to:
LinuxCertified, Inc.
349 Cobalt Way, Suite #304
Sunnyvale, CA 94085
Payment by
Credit card:
Card number: ___________________________________
Expiration: ________________
Card type (circle one): Visa Mastercard
American Express
Name on the Credit card: ________________________________________________
CID/CVV2 number:_____________(4 digit number
on top of AMEX or 3 digit number at the end of signature
panel of Visa/Master Card/Discover)
Signature: ______________________ Date: _____________
Credit Card Billing address:_______________________________________________
_________________________________________________________________________
If paying by credit card you can also fax the printed form to (425)
732-7143
Please do notify us via email when sending in the form.
I have read and I agree to the Terms and Conditions listed on website of
linuxcertified.com
Signature_________________________________________
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