ERI's Registration Form
Please provide this information via postal mail or FAX. This form cannot be submitted through the web.
Do not forget to complete the form before printing or faxing.
If you are filling out this form for the participant, please also inform his/her phone number and e-mail address.
Course chosen:
Fundamentals of Random Vibration and Shock Testing, (...)       Isolating Shipboard Electronic Equipment         
HALT/HASS/HASA and Practical Design FMEA       
Location:
Boxborough Cincinnati Fullerton Grand Rapids Hillsboro Maryland
Orlando Redford Santa Barbara Tallman (NY) Toronto  
Family Name Mr.    Mrs.    Miss
Personal Name
Organization   Website
Postal Address
Telephone Extension Student's Telephone
FAX
Registrar's E-mail Student's E-mail

We prefer payment to accompany registration form. Please check below your preference:
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Total (US$ or € ): Credit Card # and Expiration Date:

Name as it appears on card:

To Register:
FAX: (805) 966-7875 or mail to ERI - 1520 Santa Rosa Avenue, Santa Barbara, CA 93109, USA.
Phone: (805) 564-1260.

Thank you for registering. However, please note that your registration is not complete until funds have reached ERI.

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