Name of Contact*
 
Title

Company Name*
 

Address*
 
City*                                State*                              Zip Code*
          

Phone*                         Fax*                          Email*
          

Class Size (10 people minimum/25 maximum)*

 people will attend this training session.

Address where training will be held *site must have working TV & VCR or DVD PLAYER
 

Requested Dates of Training (Please provide 3 options)
Instructor prefers Tue/Wed/Thu afternoons and evenings
Option I     Date    Time   
Option II    Date    Time
Option III   Date    Time

Please remit $25 per Session Fee Requested.
I will mail a CHECK or MONEY ORDER.
          Mail to: LCSC CECE, 415 Main Street, Lewiston, ID 83501

I will use PURCHASE ORDER #, please INVOICE me.
          Fax: 208-792-2850

I will contact you by phone with my CREDIT CARD information.
          Phone: 208-792-2447 or 800-394-4189