Registration
Join us for Jackrabbit Best Practices Training Class!
Vancouver, BC - June 20 & 21, 2013
Training is classroom-style - 2 full days
Cost: $95 per person
Bring your Laptop!!!
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:
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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:
Organization / Business Name:
What type of facility do you operate?
List the status of your Jackrabbit account: (Client, Free Trial, No Account)
Number of attendees ($95 per Attendee):
First & Last Name(s) of each attendee:
Total Fee to be charged (number of attendees x $95) =
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.
Internet and Laptop Use
(Show-Hide Details)
I understand Internet will be provided for me, but I must bring my own laptop.
I've read the above and agree.
Payment
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The total amount due will be charged to the Credit Card you enter below once we process your registration. You will be emailed a receipt.
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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