Preparation for the SES QSTI Exams
Registration Form
Name:__________________________________ _____________________________________
Company:_______________________________ _____________________________________
Address:________________________________ _____________________________________
City: ___________________________________
State:___________________________________
Zip: ___________________________________
Phone:__________________________________
Extension: _______________________________
Fax: ___________________________________
Email: _________________________________
Please select method of payment (No purchase orders, please) (Check one):
O Check Enclosed O VISA
O MasterCard O American Express
Card Number:____________________________
Expiration Date: __________________________
Authorization Signature: ____________________________________________________
Print Name: _____________________________ _________________________________
Payment of $1199 must be received in our office within two weeks after sending this registration form to hold a seat.
Workshop
|
Month |
Date |
Year |
Location |
|
|
|
|
|
|
|
|
|
|
Please return the completed registration form with payment to:
Phone/FAX 919-772-7843
Or
Walt@waltersmith.com
Return to Homepage, See Prep Agenda