Solutions 2009 - (Page 62) 62 course registration To register for one or more courses, visit www.cis.tennessee.edu. Or, complete this form and mail it to: The University of Tennessee Center for Industrial Services 193C Polk Avenue Nashville, Tennessee 37210 Or, fax to (615) 253-6346. Name: Company: Street Address: City/State/Zip: Phone: ( ) Fax: ( ) E-mail: For Title VI/Title IX compliance, we ask voluntary disclosure of the following: Veteran — ❑ Yes ❑ No Gender — ❑ Male ❑ Female Race — ❑ Caucasian ❑ African American ❑ Other REGISTER ME FOR THE FOLLOWING COURSE(S). Date Date City City Fee Fee Course Title Course Title Course Title Date City Fee METHODS OF PAYMENT: ❑ Check enclosed (make payable to the University of Tennessee). ❑ Purchase order number (please attach purchase order): ❑ Credit card: Visa MasterCard Card number: Expiration date: Name as it appears on the card: Cardholder’s signature: For registration information, call (888) 763-7439. ❑ The University of Tennessee seeks to accommodate all persons with disabilities. If you require auxiliary aids, special services or other accommodations, please check this box. Someone from CIS will contact you. CANCELLATION/REFUND POLICY: A $15 service charge will be incurred for all cancellations received less than one week prior to the event date. No registration fees will be refunded to requests received less than one week prior to an event. You may apply these fees toward attending another course. Make requests to Patty Wells at patricia.wells@tennessee.edu. The University of Tennessee Center for Industrial Services, as a member of the Midwest Consortium for Hazardous Waste Worker Training, has been funded in part since 1991 by the National Institute of Environmental Health Sciences. It is pleased to work with the Tennessee Department of Environment and Conservation and Tennessee OSHA to provide the most up-to-date information and training available. The Center for Industrial Services is an agency of the University of Tennessee Institute for Public Service. Center for IndustrIal servICes (888) 763-743 • W W W. C I S . T E N N E S S E E . E D U • (615) 532-8657 http://www.cis.tennessee.edu http://www.cis.tennessee.edu http://WWW.CIS.TENNESSEE.EDU http://WWW.CIS.TENNESSEE.EDU
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