Custom Reporting in HSFIS Enrollment Form

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Enrollment Form

Required Items. Please read the cancellation policies.

Course Information

Course:

Custom Reporting in HSFIS

* Course Date:

Cost of Class:

$495 per Student

* Number of Students :

Discounts:

Note:

Early Bird Discounts are only available with Credit Card registrations only! You can choose more than one discount. Take 3 discount is for 3 or more students.

Total Cost:

Classes are occasionally cancelled. Please indicate if there is a second date in our schedule which may be acceptable to you. You will not be enrolled in this class without a confirmation by phone and/or email or fax. Please read the cancellation policies.

* Course Date:

Student Information

* Contact Name:

* Job Title:

* Agency:

* Email:

* Phone:

Fax:

Address:

Additional Students

Fill in the following fields depending on how many seats you require.

2nd Student Name:
2nd Student Email:

3rd Student Name:
3rd Student Email:

Billing Information

* Method of Payment:

PO#

Card No./Purchase Order No.:

Expiration Date

Authorizing Manager:

Additional Comments

Comments:

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Please bill the company: letter of authorization or purchase order will be faxed to (901) 758-4036. I have read and understand the registration and refund procedures for HSU courses.

HSU provides a range of services to allow persons with disabilities to participate fully in educational programs and activities. If you desire support services, contact the student Access Center at (901) 758-4034.