Chicagoland Electric Association Education Foundation

	Online Registration for CEAEF classes Spring 2019 Semester

Full Name
Company
Company Street Address
Company City, State, ZIP
Phone
Fax
Email Address

Please register me for the following classes:	Date: Date: Date:
Total Amount:
Coupon Code:
Method of Payment	(a 5% convenience fee will be added for credit card payments)
Credit Card Number
CC Exp. Date
Cardholder name
	Credit card billing address is the same as company address above If credit card billing address is different from company address, please specify below:
CC Billing Street Address
CC Billing City, State, ZIP
Signature (if printed)	_____________________________________________
	By submitting this electronic form, I authorize the CEAEF to charge the appropriate amount to the above credit card for my registration in the specified CEAEF classes (all prices are in US dollars).

If you need to include a check via postal mail or prefer not to register online, please print this page (signing it if necessary), and mail or fax it to: Electric Association Education Foundation 17W733 Butterfield Road, Suite B, Oakbrook Terrace, IL 60181 (630) 305-3050 (phone) (630) 305-3056 (fax) Note: prices may be subject to change without notice. Please contact our office if you have any questions on membership details or eligibility.