World Institute for Security Enhancement
Registration Form

Mail to:

World Institute for Security Enhancement
United States of America

Or Telephone:  +1 954-447-5184
securitytraining@pobox.com

Course Title:   Protection of Computers & Proprietary Information

Class Code: PCPI#________________

Last Name:_______________________________________________________________

First Name:___________________________________________ Middle Initial:________

Title: ___________________________________________________________________

Social Security / National ID #:______________________________________________

Company / Affiliation:______________________________________________________

Department:______________________________________________________________

Address:_________________________________________________________________

City:____________________________________________________________________

State / Province:__________________________________________________________

Zip / Postal Code:__________________________________________________________

Country: _________________________________________________________________

Office Phone:___________________________ Cellular:___________________________

Facsimile:_________________________________________________________________

E-mail Address: ____________________________________________________________

* While not mandatory, the Social Security / National ID number assures
your prompt enrollment and gives you accurate accessible educational records.