SIGNALCRAFTERS TECH, INC.
POWER LINE CARRIER SCHOOL
REGISTRATION FORM

PLC MAINTENANCE TRAINING SCHOOL
COURSE FEE: US$1,200.00 PER PERSON - TRAVEL & LIVING EXPENSES ARE THE RESPONSIBILITY OF THE ATTENDEE.
3 OR MORE PEOPLE IN ONE CLASS: US$1,150.00 PER PERSON

(FOR ACCOMMODATIONS, PLEASE LOOK UNDER TRAINING ON OUR WEBSITE OR CALL US AT 800-523-5815).

Instead of registering via the below form please contact me directly at 800-523-5815 or davej@signalcrafters.com

so I can confirm seating availability and class status.   Dave Jenkins, Director of Sales/Marketing

Please complete the following:

:COMPANY NAME
(MAIN CONTACT )
:FIRST NAME
:LAST NAME
:TITLE
:TELEPHONE # 
:FAX # 
:E-MAIL ADDRESS
:DEPARTMENT
:ADDRESS 1
:ADDRESS 2
:CITY
:STATE 
:ZIP CODE
:COUNTRY 

WHAT METHOD OF PAYMENT IS PREFERRED?
:Purchase Order #

Credit Card: We accept VISA, Mastercard, & American Express
Please call us at 1-800-523-5815 with the credit card information.

OTHER (PLEASE SPECIFY): 

HOW MANY PEOPLE WILL BE ATTENDING THE COURSE?

PLEASE LIST THE NAME(S) & TELEPHONE NUMBERS OF THE ATTENDEE(S)
(IF KNOWN AT THIS TIME)

1.    TEL #:
2.    TEL #:
3.    TEL #:
4.    TEL #:
5.    TEL #:
6.    TEL #:

WHICH DATE ARE YOU INTERESTED IN ATTENDING?
  No Choice Selected March 2013 June 2013 October 2013 : SELECT ONE

THIS REGISTRATION FORM, ONCE SUBMITTED WILL RESERVE THE DESIRED NUMBER OF PLACES FOR THE DATE SELECTED, IF SPACE IS STILL AVAILABLE.  IF THE DATE DESIRED IS ALREADY FULL WE WILL CONTACT YOU IMMEDIATELY.

WE WILL ALSO CONTACT YOU TO CONFIRM RECEIPT OF THIS ORDER. IF YOU ARE NOT CONTACTED WITHIN SEVEN WORKING DAYS PLEASE CALL US AT 800-523-5815.  IF FOR SOME REASON YOU MUST CANCEL WITHIN 30 DAYS OF THE SCHEDULED COURSE.  SIGNALCRAFTERS RESERVES THE RIGHT TO CHARGE A 25% FEE.  NO CANCELLATIONS ACCEPTED WITHIN 7 DAYS OF CLASS STARTING DATE.  NO DISCOUNTS WILL BE GIVEN FOR PARTIAL ATTENDANCE BY REGISTERED STUDENTS.

COMMENTS OR SUGGESTIONS

WE RECOMMEND THAT YOU PRINT A COPY OF THIS FORM BEFORE YOU SUBMIT IT FOR YOUR RECORDS!