To mail in your reservation, print off this page, fill in the blanks and mail to :
Instruct-online 955 Forevergreen Rd North Liberty, IA 52317
Catalog Number : __________-iol Webinar Name : Speaker : Price : $ per connection Date : ____________________
All the information below is required: Organization's Name : ______________________________ Address : ____________________ City/State/Zip : ____________________ Contact Name : ____________________ E-mail address : ____________________ Phone Number : ____________________
___ Pay by Check (Payable to : Instruct-online) ___ Pay by PO (Payable to : Instruct-online) PO#____________________ ___ Pay by Credit Card (Mastercard or Visa) Card Number____________________ Name on Card____________________ Expiration Date______ Credit Card Verification Number (from back of card)______
