Rohrer College of Business

Program Registration

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Billing Address
*First Name

*Last Name

*Job Title





*Zip Code

Note: A confirmation letter and directions to the training site will be sent to your billing address unless a mailing address is provided.

Mailing Address

Mailing Address
(If different from billing address)



Zip Code

Contact Information

*Company Phone

Home Phone

*E-Mail Address

*Fax No.

Program Information

* Program Title

* Program Date

Program Location

Program Code

Additional Information

SHRM/Tri-State/HRA member:

Payment Type

*Method of Payment

Payment in Mail
Bill My Company
Bill Me Amount     $
There is no charge for this program

Please call 856-256-4126 if you prefer to pay by credit card.