NetCourse enrollment form January 22 - March 5, 2010 ------------------------- NetCourse 101, Introduction to Stata ------------------------------------- To enroll in NC101, complete this form and return it to StataCorp by January 21 using any of the methods below. Email to: enroll@stata.com or Fax to: 979-696-4601 or Mail to: StataCorp 4905 Lakeway Drive College Station, TX 77845 or Telephone: 800-782-8272 (800-STATA-PC, USA) 800-248-8272 (Canada) 979-696-4600 (Worldwide) _________________________________________ Name _________________________________________ Email address _________________________________________ Mailing address _________________________________________ _________________________________________ _________________________________________ _________________________________________ Telephone number _________________________________________ Stata serial number __ American Express Payment method (x one that applies) __ Discover (Course cost is $95) __ MasterCard __ Visa __ Purchase Order (U.S. and Canada only) __ Check enclosed (Check must be paid in U.S. dollars and drawn on a U.S. bank) ___ I will phone or fax my credit card information. _________________________________________ Credit card/P.O. number (optional) ___________________ Credit card exp. date We like to begin each NetCourse by introducing the participants to each other via a roster. We have found that people are more willing to participate if they know just a little about each other. For example, Name: Shannon Driver University/Company: StataCorp Department: Development Position: Programmer Email address: sdriver@stata.com Please type a short description of yourself below: Name: _________________________________________ University/Company: _________________________________________ Department: _________________________________________ Position: _________________________________________ Email address: _________________________________________ NetCourse 101, Introduction to Stata Thank you. +----------------------------------------------------------------------------+ | StataCorp Tel. 800-STATAPC | | 4905 Lakeway Drive 800-782-8272 (U.S.) | | College Station, Texas 77845 800-248-8272 (Canada) | | 979-696-4600 (worldwide) | | enroll@stata.com Fax 979-696-4601 | | WWW http://www.stata.com | +----------------------------------------------------------------------------+