Name : __________________________________________________________________________________
(last)
(first)
(middle)
Company/Organization : _______________________________________ Title
: ______________________
Address : ________________________________________________________________________________
________________________________________________________________________________________
Phone : _________________________________________________________________________________
(daytime)
(evening)
E-mail : ___________________________________________________
Please check the class you will prefer to attend.
November 6 - 8,
2006 (Sunnyvale, CA)
How did you hear about us ? _________________________________________________________________
I want
to get the optional Linux laptop (additional $700 in the course fee)
Please write a check or money order for $1600 ($2300 if Linux laptop
is included) payable to "LinuxCertified, Inc." (unless paying
by credit card), and send it with this enrollment form to:
LinuxCertified, Inc.
1072 S. De Anza Blvd., Suite A107-19
San Jose, CA 95129
Payment by Credit card: Card number: ________________________
___________
Expiration: ________________
Card type (circle one): Visa Mastercard
American Express
Name on the Credit card: ____________________________________
CID 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 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_________________________________________
