TRAINING CLASS CHANGE REQUEST FORM - Hacker Halted

TRAINING CLASS CHANGE REQUEST FORM
Please use one form per registrant. This form is for those who have an existing Training registration and
have an existing Confirmation Number. If you do not have a Confirmation Number from your online
registration, you MAY NOT use this form and must register online.
Note that some classes may be sold out and your request will be based on availability.
You must return this form to us no later than September 1, 2011.
To joyce.choo@eccouncil.org or fax to 1.505.212.0828
Please use this form to mark the class you are currently enrolled in as well as the class you are interested
in taking instead. We cannot guarantee your confirmation into any particular class until we have checked
the current enrollment in the new class.
Training Courses Registered Course Requested Change
Certified Ethical Hacker (CEH) v7
Certified Security Analyst / Licensed Penetration Tester (ECSA/LPT)
Computer Forensics Hacking Investigator (CHFI)
Certified Incident Handler (ECIH) [2 days]
CAST 611 – Advanced Penetration Testing [3 days]
CAST 612 – Digital Mobile Forensics Deep Dive [3 days]
CAST 613 – Advanced Application Security [3 days]
CAST 614 – Advanced Network Defense [3 days]
CAST 615 – Cryptography Deep Dive [3 days]
Advanced VoIP: Securing UC Networks
Hacking Web 2.0 Applications (Securing Ajax, RIA & SOA) [2 days]
Wireless & Bluetooth Hacking 101 [2 days]
SAP Security In Depth [2 days]
CompTIA Security+ [3 days]
Certified Information Systems Security Professional (CISSP)
Certified Secure Software Lifecycle Professional (CSSLP)
Crimeware Attribution [2 days]

HACKER HALTED USA 2011 PAYMENT FORM
To register complete the form below as well as the Add a Class Form and return it to:
Email: joyce.choo@eccouncil.org or Fax +1 505 212 0828
Please complete this form in its entirety and legibly.
Registrant Name
_______________________________________________________________________________
Confirmation Number
_______________________________________________________________________________
□ I understand that my seat in a training class is not confirmed until payment has been received. Hacker Halted
reserves the right to cancel my Training registration should I fail to provide payment in full within 7 days of
submitting this form.
Method of Payment
□ I will be paying by Google Checkout
□ I will be paying by Wire Transfer
□ Please charge my credit card, for the amount indicated in the credit card authorization form. I understand the
credit card charge will show up as Hacker Halted USA 2011 and will be in US Dollars.