UW-Madison Continuing Studies Noncredit Registration

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REGISTER BY:

PHONE
608-262-2451
TTY 265-2370
Charge noncredit course(s) to your MasterCard, VISA 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	To contact you about your registration and for future marketing
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. University of Wisconsin provides equal opportunities in employment and programming, including Title IX and ADA requirements.

DCS Home	Classes	Services	Learners	Register	About Us	UW-Madison

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