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

Enclosed Fee:

$1,450.00 (USD) 5 Day / 40 Hour Course

Payable with a Check, Money Order or by Credit Card.

                                                          Card Number:
Signature Authorizes Deduction By Third Party Vendor
     

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.


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World Institute for Security Enhancement
www.worldinstitute.org
securitytraining@pobox.com

All Rights Reserved.