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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

Are you Hispanic/Latino?
Yes    No

Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe you:
American Indian or Alaskan native    Asian    Black or African American
Native Hawaiian or Other Pacific Islander   White   

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

How did you hear about our Executive Education courses?

Executive Education Catalog
Mini MBA brochure
RichmondBizSense.com
Facebook

Train-the-Trainer brochure
Project Management mailing
Email
Robins School website

Internet Search
UR Graduate
Past Participant
Other

Newspaper Ad (please specify):
Friend or Colleague (name):
Comments:

Payment Method:

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.

UR Tuition Remission

Name of UR Faculty/Staff

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.