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.

  August 25 - August 27, 2008 (San Jose, CA)

How did you hear about us ? _________________________________________________________________

 

Registration Fee

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

Please write a check or money order for $1599 ($2299 if Linux laptop is included) 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: Card number: _______________________________________  

Expiration: ________________

Card type (circle one): Visa     Mastercard     American Express   

Name on the Credit card: _________________________________________

For American Express give CID number_____________(4 digit # on top of card)

Signature: ________________________ Date: ________________________

Credit Card Billing address:_______________________________________

_________________________________________________________________

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_________________________________________