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Linux
Network Services Bootcamp - Class Enrollment Form
Contact
Information
Name
: _________________________________________________________________________________________________
(last)
(first)
(middle)
Company/Organization : _______________________________________
Title : ___________________________________
Address : _______________________________________________________________________________________________
________________________________________________________________________________________________________
Phone : ________________________________________________________________________________________________
(daytime)
(evening)
E-mail
: ___________________________________________________
Linux
Background
Please circle the appropriate level that describes your
expertise in Linux/UNIX networking:
Beginner
Intermediate
Advanced
Expert
Additional comments:_______________________________________________________________________
Class
Preference
Please check the class you will prefer to attend.
 September
13-14 , 2003 (San Francisco)
How
did you hear about us ? _________________________________________________________________
Registration Fee
Please write a check or money order for $1,725 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: ________________________________________________
For American Express give CID number:____________ (4 digit
number on top of card)
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 the form.
I have read and I agree to the
Terms and Conditions listed on website of linuxcertified.com
Signature_________________________________________
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