CertificationZone Honor Roll
Submission Form
Please print, complete and fax or mail this form along with your Cisco
Completion Certification to:

Genium Publishing Corporaton
1171 Riverfront Center
Amsterdam, NY 12010
Fax (518) 842-1843
(877)CCIE-NOW

Please add my name to the Certification Zone's Honor Roll

First Name: _____________________________________

Last Name: ______________________________________

Address: _____________________________________________________

City: ____________________________ State: __________ Zip: ___________

Country: _________________________________________

Zone-ID: ___________________________________

Password: ____________________________________

E-mail Address ____________________________________ (not for publication)

Phone number _________________________________ (not for publication)

Fax number ____________________________________ (not for publication)

Certification Earned (circle one) CCNA CCIE

Do you want an e-mail reply box linked to your name at the site?

Yes No

Comments (not for publication)

___________________________________________________________________

___________________________________________________________________


We will post your name on the CertificationZone Honor Roll within a few days. Your Honor Roll T-shirt will be mailed to you within two weeks (while supplies last).