Walt Medak & Associates, Inc., Voice & Data Telecommunications Design & Administration: Order Form

WMA TRAINING REGISTRATION FORM

Classes are held in Portland, OR.

Please note what class that you are registering for:

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DATE OF CLASS:

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NAME:

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TITLE:

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HOW LONG AT THIS POSITION:

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COMPANY:

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ADDRESS:

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CITY:

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STATE & ZIP CODE:

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DAY PHONE NUMBER:

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E-MAIL:

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PBX INFORMATION:

WHAT SWITCH ARE YOU USING?

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WHAT VERSION SOFTWARE ARE YOU USING?

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WHAT TYPE VOICEMAIL?

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PAYMENT TERMS:

Thank you for your registration form for our class.Please note that, due to the high demand for our training, WMA cannot complete your reservation until payment is received. In fairness to all applicants, reservations will be made on a first come, first serve basis to students presenting both the registration and payment. Unfortunately, this has become necessary due to an increasing number of applicants who have not submitted timely payment, leaving seats unfilled that could otherwise have been occupied by a disappointed student who was turned away. In the event that a particular class is fully registered, the seats will be assigned according to payment date, with others given the opportunity for seating in a subsequent class date.

PAYMENT:

CHECK / CREDIT CARD:

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INVOICE ADDRESS:

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CITY:

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STATE & ZIP CODE:

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ATTENTION FOR INVOICING:

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INVOICE PHONE NUMBER:

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INVOICE FAX NUMBER:

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CANCELLATIONS:

ONLY ACT OF GOD CANCELLATIONS WILL BE ALLOWED; OTHERWISE, NO REFUNDS WILL BE MADE. ONLY RESCHEDULING WILL BE ALLOWED. SUBSTITUTIONS MAY BE MADE BY FAXING THE NAME, ADDRESS AND PHONE NUMBER OF THE REPLACEMENT, ALONG WITH THE ORIGINAL REGISTRANT'S NAME, TO 503.251.2030.