UW Tacoma Certificate Program Admissions Form › sites › default › files › global ›...
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Registration Form 2013 - 2014 Lean Six Sigma: Green Belt Certificate Program Mail, e-mail or fax registration materials to: KeyBank Professional Development Center University of Washington, Tacoma 1900 Commerce Street Campus Box 358443 Tacoma, WA 98402-3100 E-mail: [email protected] Fax: (253) 692-4627 By submitting this registration form you acknowledge that you have read and agree to the terms and conditions located on the KeyBank PDC website. Questions? Contact us at 253-692-4618 or [email protected] Name (last) (first) (middle initial) E-mail address Mailing Address City State Postal or Zip Code Daytime Phone Evening Phone Check or money order in U.S. funds Credit card: Visa Mastercard Card Number Expiration Date Third-party payer (Name of Payer): Registration Date Cardholder Name (If different than applicant's name) University of Washington | KeyBank Professional Development Center | www.tacoma.uw.edu/keypdc | [email protected] tacoma.uw.edu/keypdc made payable to the University of Washington, Tacoma (Returned checks are subject to a $25 service fee.) Signature How did you hear about this program? Please attach purchase order or letter of authorization to bill to this application. Fees/Tuition/Refunds/Cancellations Tuition in full and registration fees are due at the time of registration. Students must submit a written or e-mail request for a refund/ withdrawal no later than 5:00 p.m. two working days BEFORE the course begins to be eligible for a tuition refund. Application ($50), registration fees ($10) and card processing fees* are non-refundable. There is no refund for tuition after the first day of class. UW Tacoma reserves the right to cancel classes or programs with low enrollment. *An additional 2% processing fee will be retained if tuition was paid with a debit or credit card. Tuition and Fees Registration Fee Tuition Total Tacoma: (10/21 - 11/20/2013) Course Code: 13FTLSS0105 Tacoma: (9/17 - 10/15/2013) Course Code: 13FTLSS0103 Tukwila: (9/10 - 10/10/2013) Course Code: 13FTLSS0101 Lean Six Sigma: Green Belt (1675) Lacey: (09/23 - 10/21/2013) Course Code: 13FTLSS0104 Courses Everett: (10/28 - 12/04/2013) Course Code: 13FTLSS0108 Payment
Transcript of UW Tacoma Certificate Program Admissions Form › sites › default › files › global ›...
Registration Form 2013 - 2014 Lean Six Sigma: Green Belt Certificate Program
Mail, e-mail or fax registration materials to: KeyBank Professional Development Center University of Washington, Tacoma 1900 Commerce Street Campus Box 358443 Tacoma, WA 98402-3100 E-mail: [email protected] Fax: (253) 692-4627 By submitting this registration form you acknowledge that you have read and agree to the terms and conditions located on the KeyBank PDC website. Questions? Contact us at 253-692-4618 or [email protected]
Name (last) (first) (middle initial)
E-mail address
Mailing Address City State Postal or Zip Code
Daytime Phone Evening Phone
Check or money order in U.S. funds
Credit card: Visa Mastercard
Card Number Expiration Date
Third-party payer (Name of Payer):
Registration Date
Cardholder Name (If different than applicant's name)
University of Washington | KeyBank Professional Development Center | www.tacoma.uw.edu/keypdc | [email protected]
tacoma.uw.edu/keypdc
made payable to the University of Washington, Tacoma (Returned checks are subject to a $25 service fee.)
Signature
How did you hear about this program?
Please attach purchase order or letter of authorization to bill to this application.
Fees/Tuition/Refunds/Cancellations Tuition in full and registration fees are due at the time of registration. Students must submit a written or e-mail request for a refund/withdrawal no later than 5:00 p.m. two working days BEFORE the course begins to be eligible for a tuition refund. Application ($50), registration fees ($10) and card processing fees* are non-refundable. There is no refund for tuition after the first day of class. UW Tacoma reserves the right to cancel classes or programs with low enrollment. *An additional 2% processing fee will be retained if tuition was paid with a debit or credit card.
Tuition and Fees
Registration Fee
Tuition
TotalTacoma: (10/21 - 11/20/2013) Course Code: 13FTLSS0105
Tacoma: (9/17 - 10/15/2013) Course Code: 13FTLSS0103
Tukwila: (9/10 - 10/10/2013) Course Code: 13FTLSS0101
Lean Six Sigma: Green Belt (1675)
Lacey: (09/23 - 10/21/2013) Course Code: 13FTLSS0104
Courses
Everett: (10/28 - 12/04/2013) Course Code: 13FTLSS0108
Payment
