Online Registration Form

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Georgia Tech Continuing Education
Online Registration Form

You
are registering for:

EE-218
MEMS Boot Camp

 

Location
and Date:

May
28-31, 2002 in Atlanta, GA (x34256)

Cost:
           $2295 If registered before
4/15/2002 for both lecture and lab, $2495 after 4/15/2002.
          
$1595 If registered before
4/15/2002 for lecture only, $1695 after 4/15/2002.

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:

·        
Submit your
credit card information online

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

·        
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.

 


VERY IMPORTANT:

After submitting your online registration,
you will receive an:

1.   
"Answer-back"
screen on your browser displaying your submitted information

2.   
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.

 

Preview
Submit Application

 

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