Registration Form
Building Lean Culture
Specialty Certification Program

*** This is NOT a secure site. ***
If paying by credit card, you MUST print this form and fax it to us. Fax: 859.323.1035
 

Date
Dr., Ms., etc....
First * Required
Middle Initial
Last * Required
Preference for
Name tag
Job Title
Department
Company * Required
PO Box
Street Address * Required
City * Required
State * Required

Province

County
(if located in KY)
Zip Code * Required
Country
Business Phone    ext. * Required
   [ex. 555-555-5555]
Cell
Fax
Email * Required
Website Address
How did you hear about our program? * Required
  Word of Mouth
  Former Attendee
  Print Ad (magazine, journal, ect.)
  Email Ad (from the University of Kentucky)
  Internet (search, website, ect.)
  Brochure
  Other
 
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*I wish to attend:
Course Title		 Fee
Course 1: Culture Awareness and Gap Analysis
 $ 1,995.00
     
November 3-5, 2008 Lexington, Kentucky
     
Course 2: Culture Implementation and Sustaining
 $1,995.00
     
November 5-7, 2008 Lexington, Kentucky
Total: $
Only the first word of the course title will show on your receipt.
If you have a special
need that may require
accommodation or assistance, please explain:

Payment is made by: 		 
Send invoice to my company    Send invoice to me
Payment/purchase order enclosed 
Purchase order No.


  Please make check/purchase order payable to: "University of Kentucky"

Cancellations made less than 10 days before the course will be subject to the full fee.

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 Signature _____________________________________________________________

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For Course Information Contact:
Arlie Hall
Email:hall@engr.uky.edu
Phone: 859-257-6262, ext. 434
Cell: 859-494-7806

For General Information Contact:
Sandra Dunn
Email:sdunn@engr.uky.edu
Phone: 859-257-6262, ext. 214
Toll Free: 800-227-6268


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