2012 campus education week early registration form - Continuing ...

2012 CAMPUS EDUCATION WEEK EARLY REGISTRATION FORM
For optimum accuracy, please print capital letters in black ink and avoid writing on the lines. Submit one completed form for each individual.
Students must be 14 or older. Registration by mail is due by Friday, August 3, 2012; the in-person early registration deadline is Saturday,
August 11, 2012, at 5:00 p.m. Please do not staple or tape checks/money orders to registration form. Duplicate this form as needed.
Last Name
Program registration is also available by telephone, 801-422-8925 or toll-free at 877-221-6716, and by Internet at http://educationweek.byu.edu.
First Name Middle Name
Mailing Address (include apartment
number if applicable)
City (include province for foreign address) U.S. State Zip Code
Country if not U.S. Foreign
Postal Code
( )
Daytime Telephone
E-mail Address
(This form is for early program registration through August 10, not for campus housing.)
Using black ink, darken only one circle.
Signature Cards may be purchased by telephone or Internet
only through August 3. (See page 55.)
-
EARLY REGISTRATION TUITION THROUGH AUGUST 10:
$69 Monday–Friday Full Day
$59 Tuesday–Friday Full Day
$66 Senior Citizen Monday–Friday Full Day (62 and over)
$56 Senior Citizen Tuesday–Friday Full Day (62 and over)
Make checks payable to Campus Education Week.
Total check amount enclosed for this registration:
$
.
Total
Payment must be made in U.S. funds drawn on a U.S.
bank. Canadian postal money orders in U.S. funds
are also accepted.
35
Male
Female
/ /
Birth Date (MM/DD/YY)
$29 Tuesday–Friday Mornings Only (8:30 a.m.–12:05 p.m.)
$29 Tuesday–Friday Afternoons Only (12:30–4:05 p.m.)
$29 Tuesday–Friday Evenings Only (4:30–9:25 p.m.)
$20 Monday Only Full Day (8:30 a.m.–4:05 p.m.)
NEW FOR 2012, EARLY REGISTRATION FOR:
$27 One Day Only (Tuesday, Wednesday, Thursday OR Friday)
$39 Tuesday–Friday Marriott Center Day Classes (8:30 a.m.–4:05 p.m.)
PLUS Campuswide Evening Classes (4:30–9:25 p.m.)
$5 Thursday evening Youth Dance (for ages 14–18)
Bank card payments are not accepted
with mail-in registrations. Bank cards
may be used for telephone and Internet
registrations through August 10.
Mail to: Campus Education Week Registration, 120 Harman Continuing Education Building—BYU, PO Box 21531, Provo, UT 84602-1531
EARLY REGISTRATION ONLY—PLEASE RETURN FULL PAGE WITH PAYMENT