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Linux Device Driver
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 4 - June 6 , 2008
(San Jose, CA),
April 7 - April 9, 2008 (San Jose, CA)
How did you
hear about
us ? _________________________________________________________________
Registration Fee
Please write a
check or
money order for $1599 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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