Registration Information

To register by fax, send completed registration form with payment information to 270-745-8974.

To register by mail, complete the registration form (or a photocopy) and send it with a check, copy of purchase order, or credit card information. Allow 3 days to process mail-in registrations. Confirmation will be mailed to you upon receipt.  Please list only one person per registration form.

Mail to:           WKU Continuing Education, 2355 Nashville Road, Bowling Green, Kentucky 42101

General Information

Name                                                                                                                                                              

Social Security no.                                                                              DOB                                                                                                                                                                                       

Address                                                                                                                                                                                              

City                                                                                      State                      Zip                                       

Day phone                                                          Evening phone                                                         

E-mail address                                                                                                                                               

Employer                                                                                                                                                        

Title                                                                                                                                                               

Fax                                                                                                      Years in HR field                                     

Payment Information

          $950 (includes CD-Rom study guide)

If payment is by check, make payable to Western Kentucky University.

If payment is by Visa, MasterCard or Discover:                                                        expiration date

Card number                                                                                                                                                   

Name on card                                                                                                                                                 

If payment is by Company Purchase Order:                                                  PO number

Company name                                                                                                                                               

Contact person and phone