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Online registration for classes

(Please register at least five business days prior to your first class session)
Full Name
Company
Company Street Address
Company City, State, ZIP
Phone
Fax
Email Address
 
Please register me for the following classes: Date:
Date:
Date:
Total Amount:
Method of Payment
Credit Card Number
Card Security Code (3 digits on back of card - example)
CC Exp. Date
Cardholder name
  Credit card billing address is the same as company address above

If credit card billing address is different from company address, please specify below:
CC Billing Street Address
CC Billing City, State, ZIP

Signature
(if printed)		 _____________________________________________
  By submitting this electronic form, I authorize the CEAEF to charge the appropriate amount to the above credit card for my registration in the specified CEAEF classes  (all prices are in US dollars).
 



If you prefer not to register online, please sign and print this page, and fax it to the CEAEF at: 708-547-9920  (fax).