UCLA Extension

Reservation Form

Submitting your reservation form secures your space. Payment or PO must be received on, or before August 18, 2017 to save 10%. Once we receive your reservation form, we will contact you with registration information. Payment is due by September 15, 2017.

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 94th Technical Management Program – September 17-22, 2017

Reg#: 355736 Technical Management Program 815
Fee: $4695 ~ see “Enrollment Information
Early enrollment fee: $4225.50 through August 18

* = required.
Name *  as it is to appear on my certificate MrMrsMs
MaleFemale
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  A1A2A3A4A5 Period 1  A1A2A3A4A5
Period 2  B1B2B3B4B5 Period 2  B1B2B3B4B5
Period 3  C1C2C3C4C5 Period 3  C1C2C3C4C5
Period 4  D1D2D3D4D5 Period 4  D1D2D3D4D5

Third Choice
Please select 1 course number for each period.
Period 1  A1A2A3A4A5
Period 2  B1B2B3B4B5
Period 3  C1C2C3C4C5
Period 4  D1D2D3D4D5
How did you hear about TMP? *
EmailBrochureReferralOnline
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