Registration
Join us for Jackrabbit training October 18, 2013 in Schaumburg Illinois!
Training is classroom-style. Please bring your laptop so you can access your own database.
When:
Friday October 18th 12pm-5:45pm
Where:
Renaissance Schaumburg Convention Center Hotel 1551 Thoreau Dr N Schaumburg, IL 60173
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:
*
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. Number of Attendees ($25 per Attendee):
3. First & Last Name(s) of each Attendee as it should appear on name tag(s):
4. Total Fee (Number of Attendee(s) x $25 =
Additional Information:
$25 Fee per Attendee
(Show-Hide Details)
I understand there is a $25 fee per attendee.
I've read the above and agree.
Payment and Cancellation
(Show-Hide Details)
Payment: The total amount due will be processed immediately. If you cancel prior to 10-01-2013 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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Exp Year:
*
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Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
*
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