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Enrollment Form
* Required Items. Please read cancellation and refund policies.
Course Information
Course:
Community Partnerships: Developing effective resource collaborations
* Course Date:
Cost of Class:
$199 per person  
* Number of Students Required:

Discounts:

   Take 3 discount is for 3 or more students registering for the same course.
Total Cost:
Classes are occasionally cancelled. Please indicate if there is a second date in our schedule which may be acceptable to you. You will not be enrolled in this class without a confirmation by phone and/or email or fax. Please read cancellation and refund policies.
Course Date:
Student Information
* Name:

* Job Title:

* Company:

* Email:

* Phone:

Fax:

Address:
Additional Students
Fill in the following fields depending on how many seats you require.
2nd Student Name:
2nd Student Email:
3rd Student Name:
3rd Student Email:
Billing Information
* Method of Payment:

Card No.  

Expiration Date

Authorizing Manager:
Check this box if your billing address is the same as your personal information.
Billing Address:
Additional Comments
Comments:
Need more information? Call 1-888-282-7817

We send out our schedule and occasional promotions. If you would rather not receive these messages, please check this box.

Please bill the company: letter of authorization or purchase order will be faxed to (901) 758-7036. I have read and understand the registration and refund procedures for HSU courses.

HSU provides a range of services to allow persons with disabilities to participate fully in educational programs and activities.  If you desire support services, contact the student Access Center at (901) 758-4034.

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