Registration A Web-based Teacher - Kovacs Consulting: Internet and Web Training

Which Course/course are You Registering For?

Your Full Name (required)

Where can I send you postal mail? (e.g., certificate of completion):
Street Address: City:
or Postal/Zip Code
Telephone number(Where to contact you during the course) (required)*

E-mail address where you will actually read your e-mail (required) *

Where do you Work? (Name of library, company, organization)

What name do you want me to address you by in email etc. while working with you?
e.g., I am called Diane or Mrs. Kovacs as you wish.

Which operating system is installed on the computer that you will use MOST OFTEN to connect to the Web site for this course?
Macintosh OS X Windows NT/2000 Windows XP Unix/Linux Windows Vista
Other
Which Web Browser will you use most often to connect to the Web site for this course?
Internet Explorer Firefox Safari Other

Which Payment Method Do You Plan to Use?**

**Please do not provide credit card numbers on this form. You will be able to connect to a Secure Web payment processing option after you complete this basic registration information form

Optional Demographic Questions:

Have you ever taught Internet or Web skills/topics to others? Yes No

What is your age? What is your Gender?

Comments or Questions

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*Privacy Statement: The information you provide on this form will be used strictly for the instructor to work with you via e-mail, postal mail, and telephone, while you are taking the courses you register for and for notifying you of future courses that might interest you. Your information will never be provided to anyone outside of Kovacs Consulting Internet & Web Training unless it is a formal request from your credit card company or by the organization that has paid your fees for the course. In those cases you will be notified of the request before the information is provided.