REGISTRATION FORM

PRINT and FAX this form to +1 (916) 933 3361

(Fill out a separate form for additional enrollees)

Please fill out the requested information on desired course(s) below:

Dates:  ____________________  Course Title:  ______________________________________________

Dates:  ____________________  Course Title:  ______________________________________________

Dates:  ____________________  Course Title:  ______________________________________________


Name of Student: _________________________________________ Mail Stop/Bldg _____________


Department:  ___________________________

Title:  ____________________________________

Organization:___________________________

Street: ____________________________________

City: _______________
Country: ________
Zip or Postal Code:________
State:___________



Phone: _______________________________
Fax: ______________________________________


__ $995   __ $1095   __ $1195   __ $1295   __ $1395   __ $1495   __ $1595
Regular Course Fee  US $1595
__ minus $100 if you are one of FATIGUE CONCEPTS Alumni
__ minus $100 if one more engineer enrolls with you
__ minus additional $100 if two or more are enrolling with you
__ minus additional $100 if four or more are enrolling with you
__ minus additional $100 if payment is received via VISA/Mastercard  or 
     by Wire Transfer to FATIGUE CONCEPTS, at least 7 days before the course start date to:
    Wells Fargo Bank, El Dorado Hills, CA 95762 USA.  ABA# 1 21000 248  A/C # 0134 010 305
	Visa / MasterCard # : ________________________________   Expiration Date: _______________
__ $895 - $995 per person for a 5-day course that is conducted at your location
__ $595 per person for a 2-day course