Online Registration Form

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Georgia Tech Continuing Education
Online Registration Form

You are
registering for:

EE-237 Emerging MEMS
Fabrication Technologies

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Location and
Date:

May 21-23, 2001 in
Atlanta, GA (x32371)

Cost:
$1595 if registered before 4/30/2001

$1795 if registered after 4/30/2001

Personal Information:
(Fields with an
ASTERISK (*) are required in order for your registration to be processed.)

Title:*

Mr.
Mrs.    Ms.

First
Name:*

Last
Name:*

Job
Title:

Company
Name:

Address
Line 1:*

Address
Line 2:

City:*

State/Province:*

ZIP/Postal
Code:*

Country:*

E-Mail
Address:*

Phone
Number:*

Fax
Number:*


(Enter “NONE” if you do not have a fax
machine.)

Social
Security Number:*


A Social Security
Number is required for Life Long Learning Tax Credits. Enter “LATER” if you would like to submit it
at a later time or if you are not a U.S. citizen.

Payment Information:

To
submit payment, you can either:

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<![endif]>Submit your credit
card information online

<![if !supportLists]>·
<![endif]>Call your credit
card information in to 404-385-3501

<![if !supportLists]>·
<![endif]>Mail a check* to
the following address:

Georgia
Institute of Technology
Continuing Education—R
P.O. Box 93686
Atlanta, GA 30377-0686

* If you register within ten working days or less before the program
begins, and you are paying by check, please bring payment with you on the
first day of the program.

Cardholder’s
Name

Credit
Card Number

Type
of Card

Expiration
Date

(MM/YY)

Other Information:

How
did you hear about our programs?

Advertisement

Brochure

Key Code    
(found on the registration
form)

Catalog

Radio

Word
of mouth

Past
Participant

Web
search engine  

Other


When did you last attend a professional development course at Georgia Tech?

Never

Within
the past year

One
to Two Years

Over
Two Years

Cancellations & Refunds:

The
Georgia Institute of Technology reserves the right to cancel a course for any
reason, including insufficient enrollment. If a course is cancelled, all
registration fees will be refunded or transferred to another course.

To
cancel your registration and receive a full refund, you must call Continuing
Education at 404-385-3501 at least 10 business days prior to
the course start date. A course cancellation received fewer than 10 days
prior to the course start date will be refunded the registration amount, less
$50 to cover the costs of materials and facilities. If you do not call
Continuing Education to cancel your registration and do not attend the
course, you are still responsible for the full registration fee. Please note
that “no shows” do not receive refunds. However, substitutions and
transfers to a subsequent course are permitted.

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VERY IMPORTANT:

After submitting your online registration,
you will receive an:

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<![endif]>“Answer-back”
screen on your browser displaying your submitted information

<![if !supportLists]>2.
<![endif]>E-mail
message from “Computer Services” confirming our receipt of your
registration

If you do not receive BOTH of
these items, then your registration has NOT
been received. Please notify us immediately
by phone at 404-385-3501 or by fax at 404-894-8925.

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Preview
Submit Application

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Georgia Tech • Continuing Education • 613 Cherry St •
Swann Bldg • Atlanta, GA 30332-0385
Phone: 404-385-3502 • Fax: 404-894-7398 • Email: conted@gatech.edu

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