HS University
 
Understanding OMB Circulars Enrollment Form 
Required Items. Please read the cancellation policies.
Student Information:
Student Name(s)   Email Address(es):
 Agency Information:
* Agency:
Contact Name:
* Job Title:
* Phone:
Fax:
Address:
City:
State:
Zip:
 Course Information:
* Course:

Early Bird Discounts:

Early Bird Discount  (See deadline dates above - Deduct $50 per person)
* Number of Students:
Specify:
Course Cost:
$425.00 per person
* Fees:

Discounts:

Take 3 Discount  (For groups of 3 or more - Deduct $25 per person)

Note:

When booking online, Take 3 discount is for 3 or more student registering for the same workshop. 
* Total Fees:
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 the cancellation policies.
Alternate Course Date::
 Payment Method:
* Payment Method:
PO#:

 Please bill the company: letter of authorization or purchase order will be faxed to (901) 758-4036. I have read and understand the cancellation policies for HSU courses.

Card No: 

Expiration Date:
Security Code: 
(3-digit security code on back of card)
Name on Card: 
Authorizing Manager:
Comments:
Payment Method:
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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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