SRC Course Registration

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Course Details

Course Name*:

Course Number*:

Course Location*:

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Course Price*:

Student Information

STUDENT TYPE*:	Customer
	Employee

STUDENT CONTACT (1):

ALTERNATE CONTACT

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Last name*:

Phone*:

Email*:

First name:

Last name:

Phone:

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You can register up to 8 students per class with this registration form

STUDENT CONTACT (2)

First name*:

Last name*:

Phone*:

Email*:

You can register up to 8 students per class with this registration form

STUDENT CONTACT (3)

First name*:

Last name*:

Phone*:

Email*:

You can register up to 8 students per class with this registration form

STUDENT CONTACT (4)

First name*:

Last name*:

Phone*:

Email*:

You can register up to 8 students per class with this registration form

STUDENT CONTACT (5)

First name*:

Last name*:

Phone*:

Email*:

You can register up to 8 students per class with this registration form

STUDENT CONTACT (6)

First name*:

Last name*:

Phone*:

Email*:

You can register up to 8 students per class with this registration form

STUDENT CONTACT (7)

First name*:

Last name*:

Phone*:

Email*:

You can register up to 8 students per class with this registration form

STUDENT CONTACT (8)

First name*:

Last name*:

Phone*:

Email*:

Billing Information

Company Name*:

Street Address*:

Street Address:

City*:

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Country*:

Attention*:

Company Phone*:

Company Fax:

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Purchase Order

Purchase Order#:

Note: FOR NORTH AMERICA ONLY. A copy must be faxed prior to enrollment USA: 1-800-284-7701 | CANADA: 1-613-784-8083.

Credit Card

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Note: FOR NORTH AMERICA ONLY. Card holders will be contacted via telephone for their credit card information.

Cost Center

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Note: This option is for Alcatel-Lucent Employees only.

Alcatel-Lucent Service Routing Certification (SRC) Program and Confidentiality Agreement

PLEASE READ THIS AGREEMENT CAREFULLY. APPLYING TO ENROLL IN ANY SRC COURSE AND/OR
TAKING ANY SRC EXAM INDICATES YOUR ACKNOWLEDGMENT THAT YOU HAVE READ THIS
AGREEMENT AND ACCEPT ITS TERMS AND CONDITIONS. IF YOU DO NOT AGREE TO THESE TERMS, DO NOT APPLY TO ENROLL OR TAKE ANY SRC EXAM.

You agree, in consideration for, and as a prerequisite to, taking any Alcatel-Lucent SRC course and/or exam, to the following terms and conditions. If you are not in agreement with the following, you will not be able to take Alcatel-Lucent SRC courses or exams. Click here to read the SRC Program and Confidentiality Agreement.
By continuing with the registration process, you are agreeing to the Alcatel-Lucent SRC Program terms.

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