DRAGON NATURALLYSPEAKING TRAINING & SOFTWARE

Registration Form

Indicate below the date and class location you plan to attend:

Date:_________________ Location:_______________________ Time:_________________________

Name:________________________________________ Male Female

Address:______________________________________ Home Phone:__________________________
(Print the address you want your certificate sent to)

City:________________________ State:___________ Zip:________ Work Phone:________________

Date of Birth:____________________ Driver’s License:___________________ SS#:_______________

Present occupation or school I am attending:________________________________________________

I am sending a $200.00 to reserve space in the class. I understand this fee is transferable as long as notification is given at least 24 hours prior to class date. Photo identification will be required for admission into class. There will be no exceptions. I have read the above and to the best of my knowledge it is true.

Method of payment:________________ Enclosed: Yes No

Name on Credit Card__________________________ Credit Card Number______________________

Credit Card Expiration Date___________________ Amount Enclosed or to be charged______________

Signature________________________________ Date__________________

*To register, mail this completed registration form to the address listed above*
or fax it to: (909) 680-4151
**This registration form may be duplicated for friends, classmates, or co-workers**