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registration — career development facilitator training - Center on

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									  RegistRation — Career Development FaCilitator training
                                                                                                                                        Fee     Enter Amount


              Summer 2011 — Section 2
              Home Study/Distance Education Hybrid: online June 7 - September 6, 2011
              (Classes in Madison: July 7-8, 2011 and August 2-3, 2011) ......................................... $1400 * $__________
              Required Materials Fee ...................................................................... ............................ $200   $__________
             * Housing, meals, and other incidental costs for
               Madison trips are additional for hybrid courses                                                                   totaL          $__________



Name ______________________________________________                                             Please provide the information requested and a
                                                                                                check for the full amount of the applicable fee.*
Job Title ____________________________________________                                                      Make check payable to:
                                                                                                        Center on Education and Work.
Organization ________________________________________
                                                                                                           Mail registration and check to:
Street Address _______________________________________
                                                                                                 Center on eduCation and Work
City, State, Zip_______________________________________                                                      Attention: Judith Ettinger
                                                                                                         964 Educational Sciences Building
Phone ______________________________________________                                                           1025 W. Johnson St.
                                                                                                            Madison, WI 53706-1796
Fax_________________________________________________
                                                                                                  PHONE: (608) 263-4779 or (800) 862-1071
Email _______________________________________________                                                       FAX: (608) 262-3063
                                                                                                    EMAIL: jettinger@education.wisc.edu
Audience level you want to focus on:
                                                                                                      Website: www.cew.wisc.edu/cdf
   K-12                       Adult


PAyMENT By
                                                                                                “Learning is a tremendous
Check:       #____________
                                                                                               pleasure with this instructor.




                                                                                                                                                               www.cew.wisc.edu/cdf
Credit Card:
                                                                                               She is always available both
   Visa                 MasterCard                   American Express
                                                                                                inside and outside of class.
                                                                                               The environment is positive,
Card Number                                                                                       educational, and fun.”
                                                                                                          CDF graduate
Expiration               Security Code




NOTE: Payment must accompany registration to reserve a
training slot. Space is limited. Acceptance will be on a first-come,
first-served basis. If training session is cancelled for any reason, a
100% refund will be issued.


* If you wish to take the course for credit as a University Special
  Student, please call (608) 263-4779 for more information.
  There is an additional per credit fee.
                                                                                           Federal Identification Number: 39-1805963

								
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