HAM RADIO CLASS ENROLLMENT

Name:

Address:

City:	State:	Zip:

Phone:	E-mail:

Which course are you enrolling in:
     Technician Class (Sat only)           ($149)
     General Class   (Sat & Sun)              ($239)
     General Upgrade Class (Sun only) ($149)

Which course location are you enrolling in:
     Burlington, VT
     Manchester, NH

All courses include the course book, workbook and on-line training course as part of the package.

Credit Card Payment information: Visa or Mastercard only

Credit Card Number:

Expiration (mmdd only - no "/" or "-"):

CVV (3 digit number on back):

Name on card:
Address on card:
City:	State:	Zip:

STOP!! CHECK AGAIN!
Make doubly sure that all of your information entered above is correct!

When you are sure that all of the information is correct, then click on SUBMIT. ONLY CLICK ONCE!
You will get a confirmation screen that the enrollment has been submitted.