UWG Logo

Advanced Technologies for Distance Education Certificate Course
Online Registration Form

INFORMATION

If you need to pay via Credit Card, please skip this form and Click Here to Register.
Your Name
Address:  
  Street 1
  Street 2
  City
  State
  Zip Code
  Country
Organization/Affiliation
  Position
Daytime Phone
Other Phone
Fax (optional)
Email
Distance Learning Experience
(please list)


FEE

$690 (includes course materials, access to online classroom and certificate upon graduation).

FORM OF PAYMENT

Purchase Order
If Purchase Order, please supply PO#

Fax Purchase Order to: (678)839-0636, attn: Dawn Senfeld. Must be received within 24 hours of registration.

I will mail a check (drawn on US funds). Please make payable to:
University of West Georgia.

Mail to:
  University of West Georgia,
  attn: Dawn Senfeld
  Distance & Distributed Education
  Murphy Building
  Carrollton, Georgia 30118

Or Call: 678.839.6248 for Help.