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Pre-Registration Form The Star Quality SmokeTest Builder° Waltham, MA (dates to be announced) ° Patent pending Cost includes a copy of the Star Quality Smoke Test Builder Kit. Pricing is based on number of students from the same company. Course payment is due at registration. You may also supply a Purchase Order # to reserve a seat in the class. Please print out the form below using your browsers "print" button and fax or mail the completed forms to:
Name of Student: ________________________________________________________________________ Title / Role: ________________________________________________________________________ Company: ________________________________________________________________________ Address: ________________________________________________________________________ City / State / Zip: ________________________________________________________________________ Phone: ________________________________________________________________________ Fax: ________________________________________________________________________ Email: ________________________________________________________________________ PLEASE USE SEPARATE FORMS FOR REGISTRATION OF ADDITIONAL STUDENTS. Method of Payment: ____ Check enclosed (payable to Star Quality ) ____ Purchase Order #____________________
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