DATASENSE, LLC - PAYMENT AUTHORIZATION AND REGISTRATION FORM
To prevent unauthorized use of your credit card DATASENSE, LLC requires that all charge card users print out
this form, fill in the data, and sign on the Authorized Signature line of this form. Please scan and email or fax a
signed copy to 661-215-9379. Confirmation will be emailed upon receipt of this form. Thank you.

Mailing Address: DATASENSE, LLC, 25101 Bear Valley Road, Suite 297, Tehachapi, CA 93561-8311
Ph: (661) 821-1909, Fax: (661) 215-9379   Email: kconger@datasense.org

1. Purchaser:
 Name: (last) ______________________(first) ________________________
Mailing address: ___________________________________ Apt./Suite: ____
City: ____________________________ State: ______ Zip: _____________
Phone: (home) (____) ________________ (work) (____) _______________
Email address:________________________________________________

2. I wish to charge my: ___ VISA© ___MasterCard© ___American Express
In the amount of: $_______________ Card number: ______________________________________
Expiration Date (MM/DD/YY or MM/YY): ______________ Security Code: ________
Exact name as it appears on card_______________________________
Billing address: ___________________________________ Apt./Suite: ____
City: ____________________________ State: ______ Zip: _____________
Phone: (home) (____) ________________ (work) (____) _______________
Email address:________________________________________________
Authorized signature: ___________________________________ Date: _________
(I HEREBY AGREE TO COMPLY WITH ALL OF THE TERMS OF THE CARDHOLDER AGREEMENT)

3. Check the appropriate option.
Prescheduling required. Private for individuals, teams, and small groups
Workshops are in our office in Tehachapi, CA (USA).
Web conference sessions are live instructor-led workshops using your data. Requires active participation and login at scheduled times; not self-paced.

___Option 1: NVivo 8 for Experienced NVivo 7 Users (Web conference only)
 Three hours: One 3-hr web conference session - 1 participant (not available to teams or groups)
Additional time is available at $125.00/hr depending upon experience and project
__Additional hours over 3 hours @ $125.00/hr - No. of hours____

___Option 2: NVivo 8 Introduction for New Users
 Six hours: Three 2-hr web conference sessions or one 6-hr day in our office
$750.00 1 participant; $675.00 each 2-4 participants (maximum 4) No. of participants_____

___Option 3: NVivo 8 Intermediate for New Users
Eight hours: Four 2-hr web conference sessions or one 8-hr day in our office
$1000.00 1 participant; $900.00 each 2-4 participants (maximum 4) No. of participants_____

___Option 4: NVivo 7 Introduction for New Users
Six hours: Three 2-hr web conference sessions or one 6-hr day in our office
$750.00 1 participant; $675.00 each 2-4 participants (maximum 4) No. of participants_____

*Cancellation charges - 50% of fee if cancelled up to 15 days prior to first workshop or session unless it is rescheduled. Refunds will not be given for non-attendance of any workshop or session. If rescheduling is required, notice must be received at least 48 hours prior to scheduled workshop or session.
*Confirmation required: Form should be faxed immediately to hold date(s) of choice, subject to email confirmation. Card is processed 14 business days in advance of workshop or session.