REGISTRATION

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REGISTRATION

Use this form to register                                       Please print clearly

Mail or fax registration form

Name (include middle initial): ____________________________________________________________________________

SS #:_________________________________________________Birthday ( - -/- -/- - - -): ____________________________

Address:____________________________________________________________________________________________

City/State/Zip:_______________________________________________________________________________________

E-Mail Address:______________________________________________________________________________________

Phone-Day:____________________________Night:____________________________Fax:_________________________

Company Name: ______________________________________________________________

COURSE SESSIONS AND TIMES

Location: Miami-Dade County

Miami Shores,

Further classes to be announced

Fee:  $725.00 (does not include textbooks)

Location: Broward County

Davie Office

INDICATE METHOD OF PAYMENT:

Check is enclosed (Payable to Barry University)      Bill my company (letter of authorization required on company letterhead.)

Charge to:      ¨ Visa         ¨ Amex        ¨ MasterCard     Authorization Number: ___________________________________________

Expiration Date:______________________________  Security Code # (3 digit on back or 4 digit on front of AM EX):___________________

Card Holder Name:____________________________________

Signature:________________________________________________

Registration will be limited on a first-come first-served basis.  A letter of confirmation and map indicating exact location will be sent one week prior to the start of the program.  If you register late or do not receive a confirmation letter by the end of the week before the start of the course, be certain to contact your site contact listed above. 

CANCELLATIONS: a request to cancel must be made at least one week prior to the start of a program.  Initial requests to cancel may be made by phone, but refunds may not be processed until a written request is received at least a week prior to the first day of the program.  If we are asked to bill a company and the registrant does not attend, the company will be billed unless the registration is cancelled in advance.  Barry University reserves the right to cancel any class because of insufficient registration.                                                                                                                    

7/09/2009