Learning Opportunities Registration

To register for any ACC CCBNO learning opportunity:

• Simply complete ALL of the following information and press SUBMIT.
• Be sure to include the date(s), name(s), and fee(s) [if any] of the session(s) for which you are registering.
• You may register for multiple sessions at the same time. Separate forms are necessary for separate individuals.

You may receive Continuing Education Credits for attending ACC CCBNO learning opportunities

• CEUs accrue at approximately .1 CEU per hour of class time.
• To receive such credits, you MUST provide your date of birth and social security number.
• The College will maintain your CEU transcript.
• You can obtain a copy of the transcript for a $5 fee.
• Contact Kelly Wagner (info below) for details.

Payments:

• You may pay for any fee-based session online by credit card (see below), by calling in your credit card info to Kelly Wagner at (512) 223-7111, or by sending a check made payable to Nonprofirt Austin to Kelly Wagner, ACC CCBNO, 5930 Middle Fiskville Rd, Austin, TX 78752.
• Refunds will only be provided if the need is the result of ACC CCBNO cancellation or changes or because of extraordinary circumstances faced by the registrant.

Email:

First Name:

Last Name:

Phone Number

Position/Title

Organization

Billing Address

City, State, Zip

Fax

Website

Second Registrant

Position/Title

Day Phone

E-mail Please avoid yahoo emails; they tend to lose our emails)

Third Registrant

Position/Title

Day Phone

E-mail Please avoid yahoo emails; they tend to lose our emails)

Please list each session for which you would like to register:
Date Course Fee
Date Course Fee
Date Course Fee
Date Course Fee
Date Course Fee

Total Fees Owed $

To Pay for Fee-Based Sessions:
Payment Method:
---Chose One Check made payable to NONPROFIT AUSTIN MasterCard VISA Discover Purchase Order **ACC does not accept AmEx.

~ Checks / Purchase Orders should be made payable to NONPROFIT AUSTIN and mailed to
Kelly Wagner, ACC CCBNO, 5930 Middle Fiskville Rd, Austin,
TX 78752.

~ Credit card information can also be called into the ACC CCBNO by calling Kelly Wagner at (512) 223-7111

Name on Credit Card

Account #

Expiration Date

Amount to be charged to account $

Session Times & Location - All programs are held at ACC's Highland Business Center unless otherwise noted. Details on room and any special instructions are e-mailed to participants a day or so before each session.

Responsible Attendance Policy -Insofar as many Center programs are free of charge or reduced price, and the program leaders are donating their time to afford the community-based and nonprofit organization community their expertise, and that sessions are conducted based upon the registration received, we ask that you commit to attending all sessions for which you register. Failure to attend, or to notify the Center of your inability to attend, may lead to your being denied access to future program services.

*How did you first hear about the session(s) you chose?
---Chose One Center Listserv Center Calendar ACC College Calendar Event Co-sponsor A Community Calendar News Source Referred/Word of Mouth Web Surfing * Other

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