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
-
Select -
Visa
MasterCard
American Express
Check (via postal mail)
(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.