Registration Form

Registration is on a first come/first serve basis.  The course is limited to 14 students.  A waiting list will be compiled in the case of a cancellation.  Application deadline is February 1, 2007. Confirmation of your registration will be sent to you after the form and deposit are processed.

Fax: 319-273-2921                                                                                    Phone: 319-273-7078 

Mail:    Linda Wiges, International Programs, UNI. Baker 59, Cedar Falls, IA 50614-0520

Name:_________________________________________ Student ID #_______________

   []    Graduate Student                        []    Undergraduate Student

        Major ____________________________________________

School Address ____________________________________________________________

City _____________________________ State _______________Zip Code_____________

Phone ______________________________ Email ________________________________

Permanent/Home Address____________________________________________________

City _____________________________ State _______________Zip Code_____________

Phone ___________________________________________________________________

Payment: (Full payment of $* is due no later than March 1, 2007)

   []$250 deposit enclosed ($100 is non-refundable) After March 1, 2007 airfare is non-refundable unless an alternate participant is available.

Remainder of payment:

   []    Check to UNI Continuing Education

       [] Please check here if you have any special needs, including dietary.  We will call you to discuss how  we can best meet your needs.  

International Programs Office requests this information for the sole purpose of registering you for this program.  We do not routinely release any of this information to anyone outside of the institution without express permission.  We do ask that you fill out all the registration items that apply to you.  We are unable to process forms that do not include your name and address.

The University of Northern Iowa is an equal opportunity educator and employer with a comprehensive plan for affirmative action.

*  

Cancellation policy:  If your plans change, please call 319-273-7078 by April 1, 2007 for a refund of your fees, excluding the $100 non-refundable deposit.  After March 1, 2007 airfare is non-refundable unless an alternative participant is available for the ticket.