Defense Industry On-Line Registration Form

Note: This form is designed for defense contractor personnel who wish to attend the DISAM SAM-CS Course. This five-day course will be offered during these times in the current Fiscal Year:

 

SAM-CS-1-2012	14 NOV - 18 NOV 2011
SAM-CS-2-2012	27 FEB - 2 MAR 2012
SAM-CS-3-2012	25 JUN - 29 JUN 2012

The current tuition cost is approximately $2,021 (subject to change) which covers all textual materials, including the textbook The Management of Security Assistance and an instructional copy of the Security Assistance Management Manual, DoD 5105.38-M. Note: Do not send money at time of registration. When the course is convened and attendance verified, the student's organization will be billed for the tuition cost. For further information please contact: CS Course Coordinator, (937) 255-8192.

Privacy Act Statement - As part of the registration information you will be requested to provide your Social Security Number. The purpose is to prevent duplicate student name entries in the data base. Privacy act 1974 as amended applies. This registration may contain information which must be protected IAW DoD 5400.11R. 

Please provide the following contact information:

Name
Position Title
Company Name
Business Address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Business Phone
FAX
E-mail
USA Citizenship	Yes No
On Base Accommodations	Yes No
Desired Class Date	SAM-CS-2-2011 27 JUN - 1 JUL 2011 1st Choice None 2nd Choice
	Send no money- (Your organization will be billed)
Billing address
Address (cont.)
City
State/Province
Zip/Postal code
Country