FAX ORDER FORM Terms and Conditions infectiepreventie I agree to the Terms and Conditions above. Basic Tutorial $299.00 Basic Workshop $299.00 Advanced Tutorial $349.00 Choose an account Customer Information Fields marked with an asterisk are required input fields. First Name * Last Name * Address * Address 2 City * State or Province * Postal Code (ZIP) * Country * Telephone Number * E-Mail Address * Choose a User Name User Name Choose a Password Password Method of Payment Please be sure to select your payment method - Choose One - Visa MasterCard Pay by credit card * Name on card * Card Number * Expiration Date * Billing Address * Billing Address 2 City * State * Zip * Fax completed form to Academy of Web SpecialistsTM 418 Main Street, Suite 9 Half Moon Bay, CA 94019
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