MEMS Boot Camp
Online Registration Form

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Georgia Tech Continuing Education
Online Registration Form

You
are registering for:

MEMS Boot Camp

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Location
and Date:

May
13-16, 2003 in Atlanta, GA (x36-238)

Cost:

$2295 if registered before 4/15/2003 (Option
1)

$1595 if registered before 4/15/2003 (Option
2)

$2495 if registered after 4/15/2003 (Option 1)

$1695 if registered after 4/15/2003 (Option 2)

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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Submit your credit card information
online

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Call your credit card information
in to 404-385-3501

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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?

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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1.

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“Answer-back”
screen on your browser displaying your submitted
information

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2.

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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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MEMS Boot Camp Online Registration Form

MEMS Boot Camp
Online Registration Form