STATA NetCourse REGISTRATION FORM

  First Name: *  

  Last Name: *   

  Address: *      

  City: *              


  State: *            State.... NSW NT QLD SA TAS VIC WA ACT

  Postcode: *    

   Phone: *           
  Please include area code

   Email: *            
  Log on details and password for the course will be sent to this email address.

   Stata 12 licence number: *            
  The Stata 11 or Stata 12 licence number can be found by typing "about" on the Stata command line.

      EFT (Electronic fund transfer)

      Credit Card - Number given over the Phone
      Credit Card - Number sent by Mail
      Credit Card - Number sent by Fax

      Cheque - Sent by mail