Registration Form

ITC18 Software Quality Assurance & Testing

Information Technology Centre
550 Windsor Street, Fredericton, N.B.

September 28, 29 & 30, 2004

Course registration and payment must be received by Thursday, September 23, 2004. Course enrolment is limited to 14 students. Please fill in the following form and return it (FAX preferable) with payment (see below) to:

Information Technology Centre ITC 18
Faculty of Computer Science, University of New Brunswick
P.O. Box 4400, Fredericton, N.B. E3B 5A3
Phone: (506) 447-3220    Fax: (506) 451-6976    E-mail: itc@unb.ca
  

Name:
 		 ______________________________________________________
Title:
 		 _____________________
Affiliation:
 		 ______________________________________________________
Address:
  		 ______________________________________________________
  
   		 ______________________________________________________
Telephone number:
 		 _____________________
Fax number:
 		 _____________________
E-mail address:
  		 _____________________

Registration fee: $1,365 ($1,186.96 + 178.04 HST) 
[or, "early-bird" discount $1,050 ($913.05 + $136.95 HST), if you register on or before September 14, 2004]

Registration includes morning coffee, refreshment breaks, lunch, course notes and a reference textbook to keep. Each student has exclusive use of a modern workstation (with zip drive) during the hands-on labs. A computer projection system is used for delivering course material.

Method of payment: (check one)

Cheque  Money Order  Purchase Order: PO # _____________________
Credit Card (VISA or MasterCard)

If Credit Card, please specify:
Card Number:
  		 _____________________
Name of Card Holder:
 ______________________________________________________
(please print or type)
  
Expiration date:
 		 _____________________
Your Signature: 

 ______________________________________________________
(required for credit card payment only)
Date signed: _____________________
  

CEU Registration: (optional)

Please register my CEUs with EIC

Technical Society/
Prof. Eng. Association:
 ______________________________________________________
Membership No. _____________________
  

Cheque or money order remitted in Canadian dollars is to be made payable to the 
"UNB Information Technology Centre".  Minimum course registration of seven students required.