Course Registration Form

Course*
Start Date*
Date Format: YYYY dash MM dash DD
Course Location*
Name (for name tag)*
First Name Last Name
Company Name and Job Title*
Company Name Job Title
Company Location*
City State / Province / Region
Email Address*
Business Phone*
Cell Phone*
In case of emergency or training class cancellations due to weather.
Billing Information
Payment Type*
We will contact you to CONFIRM your enrollment. Seats are not confirmed until payment is received. Please be prepared to provide a purchase order number or a valid credit card to process your request.
Billing Contact Name*
First Last
Billing Contact Email*
Billing Contact Telephone*
R.E. Mason Sales Contact (if known)
Your Company's Training Coordinator's Contact Information
Your Company's Training Coordinator's Name
First Last
Your Company's Training Coordinator's Email
Additional Comments
End User Confirmation*
- Yes
All R.E. Mason local courses are restricted to end users only. Please confirm by clicking "yes" that you are an end user.
Terms of Attendance*
- Yes
I understand that by registering and attending training classes, I grant permission to Robert E. Mason & Associates the rights to use my image, likeness and the sound of my voice without payment or other consideration. I understand that my image or voice may be published publicly and privately and I waive the right to inspect or approve the finished product.
Name
This field is for validation purposes and should be left unchanged.

Billing Information