Registration Form

for the course ITC25 Effective Requirements Acquisition and Management

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

February 21 and 22, 2006

Course registration and payment must be received by Tuesday, February 14, 2006. Course enrollment is limited to 20 students. At least seven course registrants are required for the course to be held. Please fill in the following form and return it (FAX preferable) with payment (see below) to:

Information Technology Centre ITC25

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

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Name:_____________________________________________________________________

Title:______________________________________________________________________

Affiliation:_________________________________________________________________

Address:___________________________________________________________________

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Telephone number:_______________________ Fax number:_________________________

E-mail address: _____________________________________________________________

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Registration fee: $962 ($836.52 + $125.48 HST) [or, “early-bird” discount $740 ($643.48 + $96.52 HST), if you register on or before Monday, February 6, 2006]

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

Method of payment (check one; cheque or money order remitted in Canadian dollars is to be made payable to the "UNB Information Technology Centre"):

Cheque Money Order Purchase Order: PO # ___________________________

Credit Card: VISA MasterCard

If Credit Card, please specify

Card Number:_________________________________ Expiration date:________________

Name of Card Holder:________________________________________________________

(please print or type)

Your Signature:_____________________________________ Date signed:_____________

(required for credit card payment)

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Optional:

Please register my Continuing Education Units (CEUs) with the Engineering Institute of Canada

Technical Society or Professional Engineering Association:

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Membership Number:_____________________________