Course Registration Application

* Represents Required Information to efficiently process Course Registration	Airline Tickets-Please do not purchase airline tickets or make nonrefundable airline reservations until you have received course confirmation. Please input required information, print this form, and fax to (202) 797-7791
Course Information
*Course Name
*Course Number
*Course Date(s)
*Course Fee

Student Information
*Student Name
Title
*Company/Organization
*Address
*City
*State
*Zip
*Telephone
Fax
Email
Company/Organization
Company/Organization
Approving Manager
Approving Manager’s Title
Approving Manager Email
Approving Manager Telephone
Additional Students Info
Student 1 Name
Email Address
Student 2 Name
Email Address
Student 3 Name
Email Address
Student 4 Name
Email Address
Payment Information
*Credit Card
*Credit Card Number
*Expiration Date
*Exact Name as it Appears on Card
*Billing Address
*City
*State
*Zip
Purchase Order
* Purchase Order Number
* Bill to the Attention Of:
*Billing Address
*City
*State
*Zip

The Training Institute of Washington, DC.

(800) 698-1191 Toll Free