Registration
Important: Please answer ALL questions under Questions/Options.
Double-check spelling of Business or Organization name under Question 1.
Double-check spelling of all first and last names under Question 6.
Double-check Credit Card information under Credit Card Verification.
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. Type of Business:
3. 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?
4. If you responded "No" to question # 3, have you viewed the Online Video Tutorials, Training Webinars and/or Jackrabbit 101 Training?
Yes
No
If Yes, please list all learning options you have experienced.
5.Total Fee: Number of people attending training x $25 =
6. First & Last Name of EVERY person attending as it should appear on a name tag. (Also include your own name if attending)
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 7-14-2014 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:
*
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
*
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
*
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