Eclipse Jumpstart - 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.

    March 31 , 2012 (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 $499 ($1199 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: _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 the form.

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

Signature_________________________________________