MEMS Boot Camp
Online Registration Form

Georgia Tech Continuing Education
Online Registration Form

You are registering for:

MEMS Boot Camp

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:

· 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?

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

MEMS Boot Camp Online Registration Form

MEMS Boot Camp
Online Registration Form