Registration, Spanish at Work, Distance Education, Ball State University

Community Spanish: A Survival Guide for English Speakers Registration

Please complete this form to enroll in the Spanish at Work program at Ball State.

Fall 2008 September 17, 24, October 1 and 8 from 6:00 - 9:00 p.m.

Items with an * indicate a required field.

First Name *
Middle Initial
Last Name *
Address Line 1 *
Address Line 2
City *
State *
Zip *
Work Phone Number *
Home Phone Number *
Fax
E-mail address *
Are you an alumnus of Ball State University?	Yes No
Payment information
Please select one of the following payment options Cost of course is $195.00
1. Check/Money Order	Yes
Make check payable to Ball State University. Please send check, along with copy of this form, to: BBC, Business Development Division CA 201 Attn: Suzie Jones Ball State University Muncie, IN 47304
2. Charge to credit card	Yes
We are currently unable to accept credit cards over the internet. If you would like to pay by credit card (Mastercard or Visa), please submit this form and call Suzie Jones at 765-285-2772.
3. Invoice my institution	Yes
Purchase Order or Memo of Authorization is required. This may be faxed to 765-285-1284.
Organization
Attention
Address
City
State
Zip Code