Fax registration form for QSR ... - QSR International



Fax Registration Form for QSR eWorkshops

Use this form to complete a faxed enrolment for an online training workshop by QSR International. Fax your completed form to QSR at +1 617 812 7783. Do not forward completed forms to QSR via email or mail.

|eWorkshop pricing |  |  |

|  |Standard price |Student price* |

|NVivo Basic : Essentials (3 x 2 hour sessions) |US$325 |US$295 |

|NVivo Advanced : Further Analysis (3 x 2 hour sessions) |US$325 |US$295 |

| | |

|All prices are in US dollars. Taxes will apply for residents of Canada. | |

|*Student pricing applies to full time students only and proof of status is required. | |

Important eWorkshop requirements

A headset or speakers and microphone are required for participation in an eWorkshop. It is your responsibility to obtain and test your incoming and outgoing audio prior to the start of the workshop. Please review ‘Is an eWorkshop right for me?’ before submitting your registration form. Your registration must be received no later than two business days prior to the start of the first workshop.

PLEASE TYPE INFORMATION BELOW OR PRINT CLEARLY

Your details

|Name: |      |

|Job Title: |      |

|Organization: |      |

|Postal Address: |      |

|City: |      |State: |      |

|Zipcode: |      |Country: |      |

|Telephone (work): |      |Cell: |      |

|Email: |      | | |

Please indicate whether you have previously participated in online instruction or web conferencing

Online courses WebEx Skype

Other I have no previous experience with web conferencing

eWorkshop details

|Enter the title of the QSR eWorkshop you wish to attend |Date |Price US$ |

|(For further details contact QSR via training@) | | |

|      |      |      |

|      |      |      |

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|Taxes (if applicable) |      |

|Note: Tax should be added to the price if you’re a resident of Canada. 13% HST applies to workshops held in Ontario, | |

|New Brunswick, Newfoundland and Labrador.14% HST applies to workshops held in Prince Edward Island. 15% HST applies | |

|to workshops held in Nova Scotia. 5% HST applies to workshops held in all other Canadian provinces and territories. | |

|TOTAL COST |      |

How to pay with this form

Use this form to make payment to QSR International in three ways. Please indicate which payment method applies:

Option 1: Credit card payment

Please indicate: MasterCard VISA American Express

|Name on card: |      |

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|Card number: |      |

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|Expiry date: |     /      |

|CVV/CVC number: | |

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| |(On your Visa or MasterCard, it’s the last three digits in the |

| |signature area on the back of your card) |

|Email address (for receipt): | |

Option 2: Check or bank draft

Make checks or bank drafts payable to QSR International (Americas) Inc. and mail to QSR International (Americas) Inc. 55 Cambridge Street, Burlington, MA 01803, USA along with a completed copy of this form. Do not provide credit card information via mail.

Option 3: Direct banking deposit

Please forward this completed form along with a copy of your deposit receipt to QSR International.

Account name: QSR International (Americas) Inc. Bank: Bank of America

Account number: 0046-2034-0353 SWIFT Code: BOFAUS3N

ABA or Routing Number: 0260-0959-3 (Wire Payment) ACH or Routing Number: 011000138 (Debit Payment) Bank address: 1414 Massachusetts Avenue, Cambridge, MA 02138 UNITED STATES

If you’re claiming the student price:

I am claiming the student discount as I am a full-time student. I have provided my current student identification with this enrolment.

QSR eWorkshop payments are also accepted online and by telephone. For more information go to the ‘How to buy’ page on the QSR website

Acceptance of terms and conditions

I have read and understood QSR’s terms and conditions (see following page).

|Your signature: | |Date: |      |

Terms and conditions

Confirmation/Cancellation/Substitution

Thank you for submitting this registration form. QSR will provide confirmation of registration and further details of the course as soon as possible. If we cannot accommodate you in this course we will offer you another course or offer you a full refund. You are welcome to allocate your place to another colleague at any time. If you do not receive confirmation by email within 48 business hours of submitting your form, please contact us at training@.

QSR reserves the right to cancel at its sole discretion any particular course or event. In the event that a specific course is cancelled by QSR, then participants enrolled in that course will be transferred to the next available course and notified of the change. In the event that QSR cancels scheduled training and you do not wish to be transferred to another course, you will be provided with a full refund of fees upon request. QSR assumes no responsibility for non-refundable airline tickets or other expenses incurred due to course cancellations so it is suggested that travel insurance be obtained to avoid loss of fares.

Cancellation fees: Cancellation fees will be at the discretion of QSR but will normally be:

More than two weeks before course - US$20 administration charge.

Between one and two weeks before course - 50% of course fee paid.

Between one day and six days before course - 75% of course fee paid.

Less than 24 hours before course - no refund.

Transfer fees: An administrative charge of US$50 will be incurred for course transfers within 2 weeks of course date.

Payment: Payment must be made within 7 days from the date of registration; otherwise your booking will not be confirmed.

Copyright

All QSR course material is protected by copyright and is not able to be copied or utilized by you or any other party without permission from QSR. This applies to the complete course materials or any part thereof.

Legal Disclaimer

QSR will use all reasonable endeavours to ensure that training activities are focused on the needs of attendees. Nevertheless, QSR cannot guarantee that all attendees’ queries will be addressed in the time allotted or that a specific level of skills will be attained as a consequence of attending the course. To the extent permitted by statute, all implied warranties as to the nature and content of QSR’s training activities are excluded and to the extent that such exclusion is not permitted, attendees’ remedies are limited to the extent permitted by the relevant statute.

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