Registration
West Coast Jackrabbit User Conference - 3 Day Event: Nov 18 - 20, 2015
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Organization Contact
First Name:
*
Last Name:
*
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State/Prov:
*
Postal Code:
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
(format=mm/dd/yyyy)
Individual Email Address:
*
Attending Day 1:
*
Attending Day 2:
*
Questions/Options:
Organization / Business Name:
Business Type
Is your Organization/Business set up in Jackrabbit?
Yes
No
If Yes, please list month and year your Organization / Business started using Jackrabbit:
If Yes, how long have you personally been working with Jackrabbit?
If No to question # 2, have you viewed the Video Tutorials,
attended Training Webinars and/or attended a Jackrabbit Basics Training?
Yes
No
If Yes, please list all learning options you have experienced:
Please list first and last names of
ALL
attendees:
Number of Attendees ($195 per Attendee):
Total Fee (Number of Attendee(s) x $195 =
Small Group Session - Would you like to participate in a small group meeting with a
Jackrabbit Team member on Wed Nov 18 between 1:00pm-5:00pm?
(You will be assigned a time slot)
Yes
No
If yes, will you arrive in Las Vegas, NV before Wednesday, November 18th?
Yes
No
List the topics you would like to discuss during the small group session:
Additional Information:
$195 Fee per Attendee
(Show-Hide Details)
I understand there is a $195 fee per attendee.
I've read the above and agree.
Payment and Cancellation
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Payment: The total amount due will be processed immediately. If you cancel prior to 11/3/2015 a refund will be processed to your credit card.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
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Exp Year:
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Address Line 1:
Address Line 2:
City:
State/Prov:
Postal Code:
*
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