UCLA Extension

Reservation Form

Submitting your reservation form secures your space. Payment or PO must be received on, or before August 30, 2021. Once we receive your reservation form, we will email you registration information.

See “Course Schedule” page for more information about each course.

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 your confirmation packet and class schedule after we receive your reservation form.

The 101st Technical Management Program – September 13-17, 2021

Reg#: 382379 Technical Management Program
Fee: $4,995 – see “Enrollment Information”

* = required.

    Name *  as it is to appear on your Award of Completion MrMrsMs
    		 MaleFemaleNB
    Job Title
    		 Company *
    Daytime Telephone *
    		 Your Email *
    Mailing Address *
    City *
    		 State *
    		 Zip *

    First Choice *
    Please select 1 course number for each period.    		 Second Choice
    Please select 1 course number for each period.
    Period 1  A1A2A3A4 Period 1  A1A2A3A4
    Period 2  B1B2B3B4 Period 2  B1B2B3B4
    Period 3  C1C2C3C4 Period 3  C1C2C3C4
    Period 4  D1D2D3D4 Period 4  D1D2D3D4

    Third Choice
    Please select 1 course number for each period.
    Period 1  A1A2A3A4
    Period 2  B1B2B3B4
    Period 3  C1C2C3C4
    Period 4  D1D2D3D4