HSFIS Courses

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Enrollment Form

* Required Items. Please read cancellation policies.

Course Information

Course:

HSFIS Basic

* Course Date:

* Number of Students Required:

Cost:

$695.00 per person

Total:

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 cancellation policies.

Course Date

Contact Information

* Contact/ 1st Student Name:

* Job Title:

* Company:

* Email:

* Phone:

Fax:

Address:

Student Information

1st Student Name:
1st Student Email:

2nd Student Name:
2nd Student Email:
3rd Student Name:
3rd Student Email:
4th Student Name:
4th Student Email:

Billing Information

* Method of Payment:

PO#

Purchase Order No.

Card No.

Expiration Date

Authorizing Manager:

Check this box if your billing address is the same as your student information.

Billing Address:

Additional Comments

Comments:

Need more information? Call 1-888-282-7817

We send out our schedule and occasional promotions. If you would rather not receive these messages, please check this box.

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.