One-Day Hands-On
Auto/Truck Electronics Troubleshooting Workshop

Registration Form

for TOWN, ON night, DATE, 2003
at the HOTEL
ADDRESS, STATE • Phone: NUMBER

Cost per Student: Varies with location
 

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To Register: Complete & Return this Form - or Call Us - or mail a copy with your payment to:
Veejer Enterprises • 3701 Lariat Lane, Garland, TX 75042-5419

Preferred method to register: fill out this page and fax to 972-276-8122 with credit card info or call 972–276–9642 to register by phone. Don't mail personal checks to register if less than 15 days before the clinic.

Students must bring their own DMM (Digital Multimeter) to the Workshop. Techs arrive and check-in by 7:30 AM to do some preliminary set-up.
Workshop beings 8:00 AM — Please be on time! We will start the workshop promptly at 8:00 AM.

 

(Please Print Clearly)

Total Number of Techs registering on this form:  _____
Student Name(s): _________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

Business Name: _____________________________________________________
Business Address: ___________________________________________________
City: __________________ State: _____ Zip: _____
Home Phone: (____) ______-__________________
Bus. Phone: (____) ______-___________________
Fax. Phone: (____) _____-___________________
Email: _____________________________

You may use: Visa, Master Card, American Express, Optima, Discover
Card Name                              Credit Card Number               Expiration Date
  _______              _______________________________     __________
Name on Credit Card: ___________________________________
Address credit card bill sent to: ___________________________________________
___________________________________________________________________
CVV2 Code: ______ (last 3 numbers in the signature box on the back)
(Check one) Corporate Credit Card ___  Personal Credit Card ___

Signature: __________________________________________

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