World Institute for Security Enhancement
Registration Form

"Technical Surveillance CounterMeasures"

Submit to:

World Institute for Security Enhancement

5840-120 West Craig Street, Suite 219

Las Vegas, Nevada  89130

United States of America

+1.702.722.7779 Voice
securitytraining@pobox.com

Enclosed Fee:

$1,250.00 (USD) 5 Day / 40 Hour Course
Payable with a Check, Money Order, or Credit Card.
     

Card Number:
Authorizes Deduction By Third Party Vendor
      

Course Title:   Technical Surveillance Counter Measures

Class Code: TSCM# ___________________

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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securitytraining@pobox.com

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