Please print this form for Rotter & Becker Course Registration

ROTTER & BECKER EDUCATIONAL CONSULTANTS

1425 Liberty Lane, Roswell Georgia 30075

email: rottera@bellsouth.net

SDU COURSE REGISTRATION

All courses are subject to minimum enrollment

Name: __________________________         Social Security #: _____________________

Address: _________________________ City: _______________  Zip: ______________

Day Phone: _______________________  Evening Phone: ________________________

E-Mail Address: __________________________________________________________

Place of Employment: _____________________________________________________

Please register me in the following ON-LINE COURSE(S):

COURSE NAME: _______________________________    COURSE #: __________ FEE: ____

COURSE NAME: _______________________________    COURSE #: __________ FEE: ____

Please register me for the LITE (Learning Integrated Technology for Educators) Course:

LITE ON-LINE COURSE (5 PLUs, 50 Hours)                                          FEE: $400

Please register me for other On-Site Course(s):

COURSE NAME: _______________________________    COURSE #: __________ FEE: ____

COURSE NAME: _______________________________    COURSE #: __________ FEE: ____

                                                                                                                         TOTAL FEES:  ____

Please make checks payable to Rotter & Becker and mail with this form to the address above.