Educational Programs and Professional Conferences Registration
Applicant Information:
 
Name:
   
First   MI   Last
If 18 or younger, Age:   Parent or Guardian:
Gender: Male     Female
Title:
Organization:
Address: 
  City: State:  Zip:
  Country:  
Phone #:
Daytime Evening Fax
Email:
In case of emergency contact:
 
Name:
Phone #:
 
Daytime Evening  
Special Needs:  If you have special needs (mobility issues, special diet, allergies, medicines, etc.) that may affect your participation in this event, please check here and provide a written description of your needs below. We will contact you to discuss accommodating your needs.
 
How did you hear about this program?
 
PAYMENT POLICY: Payment is due in full two weeks before the class or conference. Payment may be made online by proceeding, calling 605-394-2693 with your credit card information or by mailing a check to:

EPPC - M 202
SDSM&T
501 E. Saint Joseph Street
Rapid City, SD 57701

CANCELLATION/REFUND POLICY: If you register for a program and are unable to attend, a refund of registration fees (less an administrative fee of thirty percent of the course fee) will be issued if written notice of cancellation is postmarked no later than one week before the first day of class.

The School of Mines reserves the right to cancel classes with low enrollment.  In the event of low enrollment cancellation, you will be contacted at least 24 hours in advance of the class.

The registration fee for this course is $.