Registration
West Coast Jackrabbit User Conference - 3 Day Event: November 6 - 8, 2013
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:
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City:
*
State/Prov:
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Postal Code:
*
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Questions/Options:
1. Organization / Business Name
2. Is your organization/business set up in Jackrabbit systems? (You use it on a daily/weekly basis)
Yes
No
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?
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?
Yes
No
If Yes, please list all learning options you have experienced.
3. First & Last Name(s) of each Attendee as it should appear on name tag(s):
Total Fee (Number of Attendee(s) x $95 =
4. Number of Attendees ($95 per Attendee):
5. Number of attendees attending the Jackrabbit Social, Thursday November 7th:
6. Small Group Session - Would you like to participate in a small group meeting with a Jackrabbit Team member on Wednesday November 6th between 9AM - 5PM?
Yes
No
If Yes, will you arrive in Las Vegas, NV before Wednesday, November 6th?
7. List the topics you would like to discuss during the small group session:
8. Free Time Clock & Express Payroll training session Wed, Nov 6th 3pm-5pm
More Info
Yes
No
Additional Information:
$95 fee per attendee
(Show-Hide Details)
I understand there is a $95 fee per attendee.
I've read the above and agree.
Payment and Cancellation
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Payment: The total amount due will be processed immediately. If you cancel prior to 10-21-2013 a refund will be processed to your credit card.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
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Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
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