UCLA Extension

Reservation Form

Submitting your reservation form secures your space. Payment or PO must be received on, or before August 11, 2016 to save 10%. Once we receive your reservation form, we will contact you with registration information. Payment is due by September 9, 2016.

Reserve early to get your top pick of courses! If your first choice is not available, you’ll be placed in your 2nd/3rd available choice. We will email you your confirmation packet and class schedule after we receive your reservation form.

The 92nd Technical Management Program – September 11-16, 2016

Reg#: 268281 Technical Management Program 850
Fee: $4395 ~ see “Enrollment Information
Early enrollment fee: $3950 through August 11

* = required.
Name *  as it is to appear on my certificate  Mr Mrs Ms
 Male Female
Job Title
Company *
Company Address
City
State
Zip
Daytime Telephone *
Your Email *
Home Address
City
State
Zip
Home Telephone
 

First Choice *
Please select 1 course number for each period.
Second Choice
Please select 1 course number for each period.
Period 1   A1 A2 A3 A4 A5 Period 1   A1 A2 A3 A4 A5
Period 2   B1 B2 B3 B4 B5 Period 2   B1 B2 B3 B4 B5
Period 3   C1 C2 C3 C4 C5 Period 3   C1 C2 C3 C4 C5
Period 4   D1 D2 D3 D4 D5 Period 4   D1 D2 D3 D4 D5

Third Choice
Please select 1 course number for each period.
Period 1   A1 A2 A3 A4 A5
Period 2   B1 B2 B3 B4 B5
Period 3   C1 C2 C3 C4 C5
Period 4   D1 D2 D3 D4 D5
How did you hear about TMP?
 Email Brochure Referral Online
 Other  

3 ways to submit registration

Or print completed form and

Fax to:

(310) 206-2815, Attention: TMP

Mail to:

UCLA Extension
Technical Management Program
10995 Le Conte Avenue, Suite 542
Los Angeles, CA 90024-1333
Attn: Joon Lee, TMP Manager