Canadian Green Energy & Pipeline Facility Fundamentals Course Registration

Registrant:

Course Location and Date(Required)

Registrant Name(Required)

First Middle Last

Registrant Address(Required)

Street Address City Province Postal Code

Registrant Phone(Required)

Company Name

• This information is only required if you require a receipt issued jointly in the company name.

Company Name

Company Website

Main Contact

Email

Telephone

eTraining Account Registration

Please create your online account for access to the eTraining portion of your course.

Details

Please take note of your username, email address and password and store in a safe location. These are your login details to access your account.

Username(Required)

Your Email(Required)

Enter Email Confirm Email

Password(Required)

Enter Password Confirm Password

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Fee

Course & Exam

Course & Exam- $1698

Skip the Exam - $1298

Subtotal:

GST 5%

Price: $ 0.00 CAD

HST 13%

Price: $ 0.00 CAD

HST 15%

Price: $ 0.00 CAD

Total

Payment Method

Pay directly through your bank account with Interac e-Transfer

Interac

Pay by Interac e-Transfer

Please e-transfer your payment to: info@theothernasa.com

Pay directly with your Visa or Mastercard

Credit Card

Visa

Mastercard

Name on Credit Card(Required)

Card Number(Required)

Expiration Date(Required)

Security Code(Required)

Billing Address

Same as Registrant Information

Address

Street Address City Province Postal Code

Phone Number

Pay by Phone with Visa or Mastercard

Phone

Pay by Phone

We will contact you for your credit card information.

Registrant Information

Name

Address

Phone

Billing Information

Name

Address

Payment Method

Total Charge

Once we have processed your payment, we will email you a link to access your eTraining

Confirm Registration & Payment(Required)

I verify that the above information is correct and authorize NASA Corp. to charge the above amount to my credit card or contact me for my credit card information.

Confirm Registration & e-Transfer Payment(Required)

I verify that the above information is correct and will submit my payment by Interac e-transfer.

Canadian Green Energy & Pipeline Facility Fundamentals Course Registration

Registrant:

Company Name

eTraining Account Registration

Details

Fee

Payment Method

Pay directly through your bank account with Interac e-Transfer

Pay directly with your Visa or Mastercard

Pay by Phone with Visa or Mastercard

Registrant Information

Billing Information

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