UW-Madison Continuing Studies registration

REGISTER BY:

PHONE
608-262-2451
Wisconsin Relay 711
Charge noncredit course(s) to your MasterCard, VISA, Discover, or American Express card.

FAX
608-265-3163
toll-free 800-741-7416
You may fax this form if paying by credit card or purchase order.

MAIL OR DELIVER IN PERSON
Mail or bring this form with payment to: Registration Office, Pyle Center, Room 139, 702 Langdon St, Madison WI 53706

Registration Office Hours: 7:45 AM-4:30 PM, Mon-Fri.

TO REGISTER ONLINE
see Register.

UW-Madison Noncredit Registration—UW W98

Please type in requested information, print out and submit to registration office. A registration confirmation that admits you to class will be sent or given to you when your registration is received. If you prefer, a pdf version of the form is also available.

1. Participant information
Name
Company/Agency
Street Address
City
State
Zip Code
E-mail
Phone: (area code) daytime/evening

2. Class information
Class Name
Class Number
Section
Class Date
Fee

3. Payment options (choose one of four methods)
a. Check (payable to UW-Madison)
b. Bill company/agency (address above)
c. Purchase Order #
d. Credit Card:
MasterCard
VISA
American Express
Card Number
Expires
Cardholder Name

Please print this form and submit it to the Registration Office. Thank you!

NOTE: If you have a disability and desire accommodation, please advise us as early as possible. Requests are confidential.