On-Line Registration Form

To enroll in a course, please complete and submit the following form. If you need
additional assistance or would like to enroll by telephone, please contact us
at (305) 284-2150 or (305) 284-2100.

Enrollment Information:
	Course #1:

Customer Information
Billing Information
(if different)

First Name:

Middle Name:

Last Name:

Title:

Company:

Address Line1:

Address Line2:

Address Line3:

City:

State:

Zip:

Country:

Daytime Phone:

Evening Phone:

Fax Number:

Email Address:

Payment Information
	Method of Payment
	(you will be contacted to further process your order)

		Credit Card

		Purchase Order

Payment and Cancellation Policies:

Course payment is due in full prior to the first day of class. You may cancel without penalty up to ten business days prior to the start of a course. If cancellation is within ten business days of the start date of the course, there is a cancellation fee of $500. The University of Miami reserves the right to change or cancel any program at any time.

There are no refunds for failure to attend class.

Customer Information			Billing Information (if different)
First Name:
Middle Name:
Last Name:
Title:
Company:
Address Line1:
Address Line2:
Address Line3:
City:
State:
Zip:
Country:
Daytime Phone:
Evening Phone:
Fax Number:
Email Address: