Course Registration Form

Please provide this information via postal mail or FAX only. This form cannot be submitted through the web and it should not be submitted by e-mail either.

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 COTS Equipment aboard military vehicles

Location:

Participant1's Information: Full Name
E-mail
Organization
Website
Postal Address
Telephone Fax

Registrar's Information (if different from participant(s)): Full Name
E-mail
Organization
Website
Postal Address
Telephone Fax

Payment

We prefer payment to accompany registration form. Please check below your preference:

Visa

Mastercard

Check

Other

Total (US$ or € ):
Credit Card Number Expiration Date
Name as it appears on card:

Participant2's Information: Full Name
E-mail
Postal Address
Telephone Fax

Participant3's Information: Full Name
E-mail
Postal Address
Telephone Fax

To complete your registration:

Print this form and FAX it to (805) 966-7875
Or
Print this form and mail it to ERI: 1520 Santa Rosa Avenue, Santa Barbara, CA 93109, USA.

Course Registration Form

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