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 24 - 26, 2013 (San Jose, CA),       March 18 - 20, 2013 (San Jose, CA)

How did you hear about us ? _________________________________________________________________

Registration Fee

Class Registeration fee $1599

I want to get the optional Linux laptop (additional $700 in the course fee)

I want to get the optional ARM-based target single board (additional $300 in the course fee)

Please write a check or money order 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: _After reviewing your order, we will send you secure GoogleCheckout instructions for payment by credit card_

If paying by credit card, you can also fax the form to (425) 732-7143

Please do notify us via email when sending this form.

I have read and I agree to the Terms and Conditions listed on website of linuxcertified.com

Signature_________________________________________