Course Enrollment Form - Group Invoiced

Course Information

These class details will be emailed to the email address you provide below.

Course Name

Course Code

Class Date and Time

Class Location

Address

Cost $

Tuition per participant

course_unique_id

Unique ID for selecting data rows, displayed for testing purposes.

AccountingCode*

Your Information

Please fill out your information below to register for this event.

Note:

THIS IS A GROUP REGISTRATION, minimum 2 registrants. If you are registering one person, please select Individual Registration instead.
THIS IS AN INVOICED REGISTRATION. If you prefer paying with a credit card, please return and choose that option.

Company/Organization*

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone*

Work Phone

Email*

Number of Attendees*

Minimum TWO PERSONS; for one person please use the individual registration form.

Net to be billed $

Purchase Order Number*

No purchasing system? We suggest your initials and today's date, for future reference.

Attendee 1

Name1*

First Name

Last Name

Phone1*

Email1*

Attendee 2

Name2*

First Name

Last Name

Phone2*

Email2*

Attendee 3

Name3*

First Name

Last Name

Phone3*

Email3*

Attendee 4

Name4*

First Name

Last Name

Phone4*

Email4*

Attendee 5

Name5*

First Name

Last Name

Phone5*

Email5*

Attendee 6

Name6*

First Name

Last Name

Phone6*

Email6*

Attendee 7

Name7*

First Name

Last Name

Phone7*

Email7*

Attendee 8

Name8*

First Name

Last Name

Phone8*

Email8*

Attendee 9

Name9*

First Name

Last Name

Phone9*

Email9*

Attendee 10

Name10*

First Name

Last Name

Phone10*

Email10*

Attendees 11 and above

Attendee Information

Provide additional attendee Name, Phone, Email information here.

Terms and Conditions

Please read and agree to the EMTI Terms and Conditions statement which includes our cancellation/refund policy.

Agreement*

I agree to the terms and conditions referenced above.