Course Date Thursday, Jan 26, 2023 Course Time 8:30am - 4:30pm Region (City) Virtual Course Fee $625.00 Register for this course: (* indicates a required field) Vendor I.D. for processing purchase order: #37217217217080 Federal Tax ID: 746000203 Warrant to be deposited in local funds. Salutation (Mr./Ms./Dr./Cpt./....) First Name Last Name Nickname (preferred name for nametag) Name to appear on certificate Title Gov. Agency Department Address Address City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP Code Phone (ex. 512-555-1212) Cell or Alternate Phone Fax Preferred Mailing Address Mailing address for certificate of completion. Email Address Separate multiple email addresses with commas. Email Address for Invoice Are you an LBJ School Graduate? Yes No If yes, what year? Manager's Name Manager's Title Manager's Email Manager's Phone Emergency Contact Emergency Contact Phone Purchase Order # (OPTIONAL/NOT REQUIRED) Course Code If you have special accommodation needs due to a disability please contact us at 512-475-8100.Cancellation PolicyCancellation Policy: Cancellations may be made in writing via email to gcmd@austin.utexas.edu. Participants must notify their agency liaison and the Governor's Center for Management Development if they must cancel. Cancellations received three (3) or more days before the class date for virtual classes and seven (7) or more days before the class date for in-person classes will not be billed. After that, cancellations or rescheduling are subject to the entire class tuition. Substitutions for registered participants will be accepted up to the start date for each class. Please note that if you don't cancel and don't attend, you will be billed for the full tuition. Agree to policy. I have read, understand, and will comply with the above cancellation policy. Leave this field blank
