EXECUTIVE EDUCATION PROGRAMS

Applied Management Principles (AMP): Online Registration

PLEASE NOTE that this is a registration form for industry participants and Purdue faculty and staff only.

Attendance by Ph.D. students from Purdue is conducted by a separate nominating process by the Dean's office of your school/college. If you are a Ph.D. student you will not be registered by this form.

Please provide as much information as possible (Bold fields are required for submission):

Contact Information:
First Name:
Last Name:
Call name:
E-Mail Address:
Title:
Organization & Address:
Business Phone:
Fax:

Program Fee: The registration fee for industry is $4,995. We offer a discount for multiple attendees from the same company. This fee includes all materials and some meals, but does not include lodging. Purdue faculty and staff should contact Cathy Garrison (garrison@purdue.edu) for the fee.
	I wish to be invoiced.
	I wish to pay by credit card. Please contact me by phone for the credit card information.
	Note: Please DO NOT input your credit card number on this form, as there is no encryption enabled at this time.

Program Lodging :
	I will stay at the Purdue Memorial Union Club Hotel, adjacent to the program, where the rate is approximately $97.00 per night plus tax. Purdue will make my hotel reservation upon receipt of my registration and I will make payment to the hotel upon checkout.
	I do not need lodging or will arrange my own; however, I do need a parking pass (take a ticket to enter the garage and we will give you a parking pass to leave the garage and to use the rest of the program).

Optional Information:
How did you hear about us?
Are you a graduate of Purdue? If so, what was your degree, major, and graduation date?
I request special seating, services, or meals. Please contact me as noted above.

Please Note: Purdue University is not responsible for expenses incurred due to cancellations.

This program is a continuing education activity of Purdue University, an equal access/opportunity university.

Cancellations, made up to four weeks prior to the start date of the program, will receive a full refund less a $75 processing fee. No refunds will be made on cancellations after that date.

All cancellations must be made by phone to Krannert Executive Education Programs at 765-494-1554; and in written form by fax to 765-496-3482, attention: AMP Registration; or by email to AMP Registration.

Thank you for registering for the AMP Program! We look forward to meeting you.

Applied Management Principles (AMP): Online Registration

Contact Information:

Program Fee:

Program Lodging :

Optional Information: