Registration Request for Kebcor.com Training

Please complete and send this form. 
We will advise you promptly of course availability, costs and contact information.

Name: ____________________________________

Agency Address: ____________________________

City: _________________   State : ____  Zip Code: __________

Phone (with Area Code) __________ Fax (with Area Code) __________  

E-mail: _____________@_________

Title-Rank: _________________  Agency: ____________________________

Course Title: ______________________________________________________

Location: _________________  Date(s): ________________

    Payment Information:

 Enclosed is my check payable to: Kebcor.com
P.O. Box 7703
Gurnee, IL 60031-7703
Bill my Agency (as follows): Purchase Order#: ______________

      Person to whom billing is to be sent:

      Title/Name: _______________________

     Agency Address: (If different from above) _______________________________

     City : _______________________ State :_____Zip Code: __________

     Phone (with area code): __________________E-mail:_____________________

 

This Registration Request Form may be photocopied for multiple enrollments.

 

Contact Kebcor.com for questions on course tuition and host information.

Mail completed form to Kebcor.com, P.O. Box 7703, Gurnee, IL 60031-7703
or Fax it to Kebcor.com (847) 816-3503 (with check mailed separately)

Student registering can pay by check in advance, at the door by check or cash, or be invoiced via P. O. upon completion of the course. 

Please include Purchase Order Number with registration requests.

Kebcor.comís Tax  I. D. is: 36-4430491 our telephone number is: 847-362-5144

You may also request registration for Kebcor.com training on line at www.kebcor.com/course_registration.htm

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