NetCourse enrollment form      January 22 - March 4, 2015
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NetCourse 471,  Introduction to Panel Data Using Stata
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To enroll in NC471, complete this form and return it to StataCorp by
January 21 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 $295)
__  MasterCard
__  Visa
__  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 

___________________                        Credit card exp. date

___________________                        CVV code


We like to begin each NetCourse by introducing the participants to each other
via a roster. We have found that people are more willing to participate if
they know just a little about each other. For example, 

                  Name: Joe Smith
    University/Company: Somewhere University
            Department: Statistics
              Position: Professor
         Email address: jsmith@somewhere.com

Please provide a short description of yourself below:


                  Name: _________________________________________

    University/Company: _________________________________________

            Department: _________________________________________

              Position: _________________________________________

         Email address: _________________________________________
  

NetCourse 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      |
+----------------------------------------------------------------------------+