CacheBack Course Registration
and Tuition Payment Form

Please complete the following form, print it, and then fax it to our office at 1-905-686-6801. If you are registering for more than one student, complete the entire form ONCE and then only send us a copy of Page 1 of this form (Student & Billing sections) for EACH additional attendee.
NOTE: This course is only offered to new and existing users of CacheBack. Students who are not licensed must purchase a copy of CacheBack along with their tuition at a 50% discount ($274.50 USD).

STUDENT INFORMATION:
Full Name:
Name to appear on Certificate:
Organization:
Position (and/or Rank):
Street Address:
Street Address:
City or Town
State/Province:
Zip/Postal Code:
Country:
Telephone:
Fax:
Email Address(s):

BILLING INFORMATION: (as it appears on your credit card)
Bill To Name:
Organization:
Street Address:
Street Address:
City/Town:
Province/State:
Postal/Zip Code:
Country:
Telephone:
Fax:
Email Address(s):

PAYMENT INFORMATION:

Please complete all sections below. Canadian residents add 13% HST. If you are entitled to a Special Promotion, then you will need to calculate the tuition and shipping costs manually.
Version 2 users will automatically qualify for a free upgrade to Version 3!

Course Name:

Date / Location:

Tuition Options:

To redeem your discount training voucher, enter the original Invoice#, Purchase Order# or Voucher # issued:

NOTE: Purchased CacheBack licenses will be provided at the course. Otherwise, please choose a shipping option below..

Shipping of Purchased Software (optional):

If your tuition option comes with a licensed copy of CacheBack and you would prefer to receive the software at the course, then please choose option #4.

Special Promotion:

Please Describe:

Seat Quantity:

Payment Amount:

Payment Type:

Card Type:
Card Number:
Cardholder Name:
Expiry Date:	/
CVC # (optional):
I hereby authorize SiQuest Corporation to charge my credit card in the amount specified above. I understand that my payment will be applied towards the tuition costs (and software, if applicable) associated to the above noted Course and Location. ___________________________________ Signature of Cardholder Date Signed: