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Do NOT use this form
to register for a training. Please use the WomenTech: Train-the-Trainer
Workshop Order
Form or the Recruiting Women to Policing Workshop Order Form in the more info box on the training page.
Mail this form to: National IWITTS, 1150 Ballena Blvd, Suite 102, Alameda,
CA 94501-3682 or fax this form to (510) 749-0500. Contact IWITTS via email (510) 749-0200. Shipping information click here
Item number can be found at the bottom of each product page, near the
price.
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Shipping
1 item = $7.95,
2 items = $11.95,
3 items = $15.95,
4 items = $19.95,
5 or more items = $22.95. An additional $15 flat rate fee will be
added for Hawaii, Alaska, and Canada.
Tax: CA residents pay 8.75%
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Method of Payment
(All orders must be prepaid or include a P.O. Number)
______Check
National IWITTS Federal ID # is 522059171
Make check payable
to National Institute for Women in Trades, Technology & Science(National
IWITTS)
______Purchase Order
No._______________________________
______Credit Card* PLEASE COMPLETE "CUSTOMER BILLING INFORMATION" SECTION AT THE BOTTOM OF THE FORM
Billing Information
________________________________________________________
Name/Job Title
________________________________________________________
School/Organization/Company/Department
________________________________________________________
Address
________________________________________________________
City/State/Zip
________________________________________________________
E-mail
________________________________________________________
Phone
________________________________________________________
Fax
Shipping Information (If different from billing)
________________________________________________________
Name
________________________________________________________
School/Organization/Company/Department
________________________________________________________
Address
________________________________________________________
City/State/Zip
________________________________________________________
E-mail
________________________________________________________
Phone/Fax
Credit Card Billing
Information
_____ Mastercard or _____ Visa
___________________________
Credit Card Number |
_____________
Expiration Date |
________________________________________________________
Signature of Cardholder
________________________________________________________
Is this a company card? If yes, please indicate name of company on card.
________________________________________________________
Address (your billing address must match the address on your credit card
statement or your credit card may be declined)
________________________________________________________
City/State/Zip
________________________________________________________
Phone
Mail this form to:
National IWITTS, 1150 Ballena Blvd, Suite 102, Alameda, CA 94501-3682
or fax to (510) 749-0500. Contact IWITTS via email or call (510) 749-0200
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