Registration

Registration

Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Organization Contact

	First Name:*	Last Name: *
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State/Prov: * Postal Code: *

Questions/Options:


1. Organization / Business Name:
2. Is your Organization / Business set up in Jackrabbit systems?
If Yes, please list month and year your Organization / Business started using Jackrabbit.
If Yes, how long have you personally been working with Jackrabbit systems?
3. If you responded No to question # 2, have you viewed the Jackrabbit Online Video Tutorials, attended Jackrabbit Software Training Webinars and/or attended a Jackrabbit 101 Training?
If Yes, please list all learning options you have experienced.
4. Number of Attendees ($25 per Attendee):
5. First & Last Name(s) of each Attendee as it should appear on name tag(s):
6. Total Fee: Number of Attendee(s) x $25 =

Additional Information:

$25 Fee per Attendee

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I've read the above and agree.

Payment and Cancellation

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I've read the above and agree.

Enter your Full Name:

*

Other Questions/Comments:

Credit Card Verification:

Card Number: *

Name as it appears on card: *

Nickname:

Card Expiration Month: *

Exp Year: *

Address Line 1:

Address Line 2:

City:

State/Prov: Postal Code:*