5920 Nall
Suite 303 Phone Number 913-432-4022
CLASS NUMBER
____________________________________________
CLASS TITLE ____________________________________________
CLASS DATES
____________________________________________
FIRST NAME _________________
LAST NAME ____________________
COMPANY
________________________________________________
ADDRESS ________________________________________________
CITY _____________________ STATE ________ ZIP CODE ________
MAILING ADDRESS (if
different than Company Address)
____________________________________________________________
____________________________________________________________
PHONE NUMBER (AREA
CODE) _______________________
FAX NUMBER (AREA CODE) _______________________
EMAIL ADDRESS ____________________________________
PAYMENT METHODS
_____ I will forward a
copy of government purchase/training order.
_____ Full payment will
be forwarded by check.
NOTE: Payment for class/courses should be made 30
days before the class is to start. If
payment is not received within 15 days of the class start date, your enrollment
will be cancelled.