Course Date Tuesday, Jul 25, 2023 to Wednesday, Jul 26, 2023 Course Time 8:30am - 4:00pm Region (City) Virtual Course Fee $675.00 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 - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon 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) If choosing to pay be credit card, please provide information below. Email Address where the credit card link will be sent Name for Credit Card Payment Check to obtain TSBPA CPE credits 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
