UW-Madison Adult Career and Special Student Services Workshop Registation A registration confirmation will be e-mailed to you when your registration is received. 1. Participant information First Name Last Name 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 Authorized use only-M Date Location Deadline Fee $65 Authorized use only-S Date Location Deadline Fee $65 Authorized use only-MW Date Location Deadline Fee $0 Authorized use only-SW Date Location Deadline Fee $0 3. Payment information Payment Method Select Payment Method... No Charge Credit Card Doing Business As: The charge will appear on your credit card statement as UW Adult/Student Services. Refund Policy: If you are unable to attend the workshop, we will refund your purchase price minus a 5% transaction fee through one week before the workshop. After that date we will be unable to issue refunds. Privacy Statement: UW-Madison does not sell, rent, trade or distribute any personally identifiable information obtained from clients to a third party, except in cooperation with government agencies or as required by law. Information collected by the UW-Madison is used for the administrative and operational purposes of our services. Contact: Please contact Adult Career and Special Student Services, firstname.lastname@example.org, 608-263-6960 if you have any questions about your registration. Thank you! NOTE: If you have a disability and desire accommodation, please advise us as early as possible. Requests are confidential.