Direct Marketing REGISTRATION REQUEST FORM
(Print & Fax to 970-491-7885, Attn: Continuing Education c/o RMDMA)

Name

Last, First________________________________________ M.I.____

Address (home)___________________________________________

City_____________________________State________Zip_________

Phone (day)___________________ (eve)_______________________

E-mail________________________ Fax_______________________

Employer________________________________________________

Social Security or ID #______________________________________

RMDMA Membership #_____________________________________

Class Location___________________ Start Date_________________

Course: DS450A (Begins September 8, 2003)

Payment is required at time of registration

I am enclosing a check payable to Colorado State University._________

Charge my credit card. (Circle one)
Visa     MasterCard     Discover     Amex

Card #__________________________________________

Expiration Date____________________________________

Name on card_____________________________________

Signature_________________________________________

Bill my company:

Company Info – Dept. _________________________________

Address_____________________________________________

City, State, Zip________________________________________

Course Fees (circle which apply):
$495.00 per course for RMDMA members
$615.00 per course for non-members

$10.00 Building access key (code D03F DEPKEY)

Books and course materials are extra (see requirements with course information following). There is an additional $75.00 charge payable to RMDMA for testing and certification. There are parking options available for students. Please ask about parking when placing your registration. There is a $10 building pass required to access the building - request this pass when placing your registration through CSU.