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

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.