DELORGE INTERNATIONAL UNIVERSITY CENTRE
Continuing Education Registration Form

Attention Prospective Student:

Shown below, you will find a course pre-registration form to be completed for training and development purposes.  All courses are provided for continuing education credit only (C.E.U's).  After completing the registration form, simply submit the form electronically to our office.  A student services representative will contact you to finalize your registration information and to officially enroll you in your selected course.   

* Required fields
Name *
E-mail Address *
Mailing Address
City/Town
State
Zip Code
Daytime/Work Telephone Number
Home or Cell Telephone Number
Identification No. (Last 4 digits of Social Security No.)
Organization/Company/Institution you are affliated with. Contact Supervisor's Name, Address, and Funding Code
Business Solutions Service(s) Requested *
Course(s) / Seminars you are registering for (include course number, title, and cost of course)
Enrollment Program Type *
Registering for an ED2GO Continuing Ed. Course *
Total Tuition Cost for Registered Course and/or Service:
Form of Payment for Tuition *
Name of High School, Colleges, Career Training, and/or Universities Attended:
Academic Session You Are Registering For: *


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Thank you for registering with the DeLorge International University Centre School of Professional Studies in Business Continuing Education .