DIRECTED ENERGY PROFESSIONAL SOCIETY Optics Course Registration 26 March - 20 May 2012 Distance Learning Thank you for your support of DEPS activities. This form permits you to register for the Optics Course to be offered via distance learning, available online from 26 March to 20 May 2012. Multiple forms of payment are offered, including using our secure server to pay on-line at this time. Asterisks note the fields required by DEPS to process your registration.     Registrant's Personal Information * First & Last Name:    Title (Dr., Ms., Major, etc.): * Organization:   * Address: * City: * State: * Zip code:   * Phone: * E-mail: * E-mail (confirm):   To reduce errors, we ask that you enter your email a second time.      Cell Phone:    Alternate E-mail:   Note: Use the Alternate Email field if you wish to have confirmation emails sent to a secondary address such as administrative personnel. This does not include the credit card receipt for on-line payment, sent only to the primary email address.     Please check here if you require special assistance     Course Fee: $1200 $1200 Registration, Textbook included   Payment *     Submit credit card payment at this time using our secure server     Send payment to DEPS   Cancellation Notice Persons requesting cancellation through 2 March will receive a full refund. Cancellations after 2 March are subject to a $100 cancellation fee. No refunds will be given after 23 March. Once you have completed the fields on this form, press the Submit button to process this information. You will be given a chance to review your registration prior to final submission. The Reset button will clear the entire form.         Copyright 2012 Directed Energy Professional Society   DHTML/JavaScript Menus by OpenCube

Last updated: 11 January 2012