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Embedded & Real Time Linux Development - Class Enrollment Form
Contact Information
Name :
__________________________________________________________________________________
(last)
(first)
(middle)
Company/Organization
:
_________________________________ Title : __________________________
Address :
________________________________________________________________________________
__________________________________________________________________________________________
Phone :
__________________________________________________________________________________
(daytime)
(evening)
E-mail :
___________________________________________________
Class Preference
Please check
the class
you will prefer to attend.
 June 9 - May 11,
2008 (San Jose, CA),
How did you
hear about
us ? _________________________________________________________________
Registration Fee
I want to get the optional Linux laptop
(additional $700 in the course fee)
Please write a
check or
money order for $1599 ($2299 if Linux laptop is included) 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: ____________________________________
For American Express give CID number_____________(4 digit # on top of
card)
Signature: ______________________ Date: ________________
Credit Card Billing address:____________________________________
___________________________________________________________
If paying by credit card, you can also fax the form to (425) 732-7143
Please do notify us via email when sending the form.
I have read and I agree to the Terms and Conditions listed on website of
linuxcertified.com
Signature_________________________________________
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