Gatton Executive Education Center

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REGISTRANT INFORMATION (press TAB to advance in the form)
Once we receive your registration, you will receive a confirmation packet via mail.

*Registrant Name:
    

*Badge Name:

Company Name: 
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Address:
City: State: Zip Code (+4): -

Business Phone: Extension: Business Fax:
E-Mail Address:

SHRM Member: No Yes (if so please provide number)

Are you a University of Kentucky Alum: No Yes

Degree year:

Are you a UK Gatton College of Business and Economics Alum: No Yes

PAYMENT INFORMATION

Check (please do not send PO's)
Credit Card - we accept Visa, Mastercard, and American Express (phone 800-284-6407 or fax (859) 257-4822 to provide credit card information)
JV (For UK internal use only)

Make check payable to:

Gatton Executive Education Center (EEC)
University of Kentucky
227 Gatton College of Business & Economics
Lexington, KY 40506-0034

Do you wish to receive CE credits: YES NO
(If "YES", you will be asked for social security number at registration.)

Have you ever attended any IBMC program in the past?
YES NO

How did you hear about this program:
Other

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