HSFIS System Administration Enrollment

HS University

HSFIS - System Administration Enrollment Form

Required Items. Please read the cancellation policies.

Student Information:

1st Student Name:

1st Student Email:
2nd Student Name:
2nd Student Email:

3rd Student Name:
3rd Student Email:

Agency Information:

* Agency:

Contact Name:

* Job Title:

* Phone:

Fax:

Address:

City:

State:

Zip:

Course Information:

* Course::

* Number of Students:

* Fees:

$249.00 per person

Discounts:

Note:

When booking online, Early Bird Discounts are only available with Credit Card registrations!

Take 3 discount is for 3 or more student registering for the same workshop.

* Total Fees:

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.

Alternate Course Date::

Payment Method:

* Method of Payment:

PO#:

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.

Card No.

Expiration Date

Security Code: (3-digit security code on back of card)

Name on Card:

Authorizing Manager:

Comments:

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

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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.

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