NetCourseNow enrollment form ---------------------------- NetCourseNow 471, Introduction to Panel Data Using Stata -------------------------------------------------------------------- To enroll in NCNow471, complete this form and return it to StataCorp using any of the methods below. Email to: enroll@stata.com or Fax to: 979-696-4601 or Mail to: StataCorp 4905 Lakeway Drive College Station, TX 77845 or Telephone: 800-782-8272 (U.S.) 800-248-8272 (Canada) 979-696-4600 (Worldwide) _________________________________________ Name _________________________________________ Email address _________________________________________ Mailing address _________________________________________ _________________________________________ _________________________________________ _________________________________________ Telephone number _________________________________________ Stata serial number __ American Express Payment method (x one that applies) __ Discover (Course cost is $495 for 1 person; __ MasterCard $395 each for 2-5 additional people; __ Visa more than 5, $195 each) __ JCB __ Diner's Club __ Purchase Order (U.S. and Canada only) __ Check enclosed (Check must be paid in U.S. dollars and drawn on a U.S. bank) ___ I will phone or fax my credit card information. _________________________________________ Credit card/P.O. number (optional) ___________________ Credit card exp. date ___________________ CVV code Additional participants: Participant 2 Participant 3 -------------------------------------+-------------------------------------+ Name | | | | -------------------------------------+-------------------------------------+ Email | | | | -------------------------------------+-------------------------------------+ Serial no. | | | | -------------------------------------+-------------------------------------+ Participant 4 Participant 5 -------------------------------------+-------------------------------------+ Name | | | | -------------------------------------+-------------------------------------+ Email | | | | -------------------------------------+-------------------------------------+ Serial no. | | | | -------------------------------------+-------------------------------------+ NetCourseNow 471, Introduction to Panel Data Using Stata Thank you. +----------------------------------------------------------------------------+ | StataCorp Tel. 800-782-8272 (U.S.) | | 4905 Lakeway Drive 800-248-8272 (Canada) | | College Station, Texas 77845 979-696-4600 (worldwide) | | Fax 979-696-4601 | | enroll@stata.com WWW http://www.stata.com | +----------------------------------------------------------------------------+