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Enrollment Form
* Required Items. Please read cancellation policies.
 
Course Name:
HSFIS System Administration
Contact Information
* Contact Name:
* Job Title:
* Company:
* Email:
* Phone:
Fax:
Address:
 
1st Student Name:
1st Student Email:
2nd Student Name:
2nd Student Email:
3rd Student Name:
3rd Student Email:
4th Student Name:
4th Student Email:

Course Information

* Course::
 Number of Students 
 Cost:
 $695.00
 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 cancellation policies.
Location:
 
Billing Information
* Method of Payment:
PO#

Card No.  

Expiration Date

Authorizing Manager:
Check this box if your billing address is the same as your personal 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.
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