Registration Form
Project Management

*** This is NOT a secure site. ***
If paying by credit card, you MUST print this form and fax it to us. Fax: 859.257.1071
 

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

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
  Print Ad
  Email Ad
  Internet Ad
  Other

Project Management
$2,200.00

TBA

 

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.

*** This is NOT a secure site. ***
If paying by credit card, you MUST print this form and fax it to us. Fax: 859.257.1071

Circle One:

Visa  
MasterCard
American Express
Discover

ard Number_____________________ Expiration Date ______________

Security Code________ Billing Address Zipcode _____________
 
Cardholder
 Signature _____________________________________________________________

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For more information, contact Sandra Dunn
UK Center for Manufacturing
220 CRMS Building
Lexington, KY 40506		 Phone: 859.257.6262 ext. 214
Fax: 859.323.1035
Email: sdunn@engr.uky.edu