HSFIS Advanced Enrollment

HS University

HSFIS Day 2 - Advanced 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:
Course Cost:	$499.00 per person
* Fees:
Discounts:	Take 3 Discount (For groups of 3 or more - Deduct $25 per person)
Note:	When booking online, 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:

* Payment Method:

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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