Linux/UNIX System and Network Security Bootcamp - Class Enrollment Form

Contact Information

Name : __________________________________________________________________________________
               (last)                                      (first)                                    (middle)

Company/Organization : _____________________________________ Title : ______________________

Address : ________________________________________________________________________________

_________________________________________________________________________________________

Phone : _________________________________________________________________________________
             (daytime)                                                                (evening)

E-mail : ___________________________________________________

Linux Background

Please circle the appropriate level that describes your expertise in Linux/UNIX networking:

Beginner           Intermediate           Advanced           Expert

Additional comments:_______________________________________________________________________

Class Preference

Please check the class you will prefer to attend.

    April 3-4 , 2004   (San Francisco)

How did you hear about us ? _________________________________________________________________

Registration Fee

Please write a check or money order for $1,500 payable to "LinuxCertified, Inc." (unless paying by credit card), and send it with this enrollment form to:

LinuxCertified, Inc.
1072 S. De Anza Blvd., Suite A107-19
San Jose, CA 95129

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 number on top of card)

Signature: _______________________________    Date: ______________________

Credit Card Billing address:______________________________________________

________________________________________________________________________

If paying by credit card you can also fax the printed 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_________________________________________