Linux Kernel Internals - 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.

  May 17 - May 18, 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 $1100 ($1799 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_________________________________________