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To register for a class, complete this form and submit it to us. You may also print out this registration form (requires Adobe Acrobat Reader) on your printer and either mail it or fax it to us at (804) 289-8872.

(Fill in and press TAB on your keyboard to proceed to next box. For multiple registrations, first press Register button at the bottom of this form, then Clear Form to enter the next person. If you need to review our list of programs, refer to our list of courses.)

All information provided will be kept in strict confidence
Name:     Home Address:    
City:     State:    
Zip:        
Organization/Company:     Title:    
Business Address:     City:    
State:     Zip:    

Telephone (work)   

(home)    

May we contact you via e-mail?    Yes  No

E-mail   

Date of Birth    

Gender:    Male     Female

Are you a UR alumna/us?    yes No

Year of Graduation   

Degree    
Courses Course Date Fee
         Total: 

Group Registration

Ethnic Group: (optional)
American Indian/Alaskan native    Asian/Pacific Islander    Black Non-Hispanic
White Non-Hispanic   Hispanic    Multiracial

Citizenship: US Citizen Other citizenship (Country/ Visa Type )

How did you hear about our Executive Education courses?

Executive Education Catalog
Mini MBA brochure

Train-the-Trainer brochure
Project Management mailing
Email

Internet Search
UR Graduate
Past Participant
Newspaper Ad (please specify):
Friend or Colleague (name):
Comments:

I would like to pay with a credit card (a representative of the Robins School of Business will contact you to get your credit card information) or fill out this Registration form (requires Adobe Acrobat Reader) and mail or Fax it to us.

I will be paying with a check.

When you click the register button, a confirmation screen should be displayed showing
that the above information has been received and is being processed. If this screen is not displayed, please contact the Robins School of Business at 804-289-8019.