continuing education at the University of Utah
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MAIL REGISTRATION AND PAYMENT TO:

Continuing Education
University of Utah
1901 E South Campus Dr. #1185
Salt Lake City, UT 84112
PH: 801-581-6461
FAX: 801-585-6490
Email: register@aoce.utah.edu

Student Registration Information
Fields with an * are required.

Title:  
*Student First Name:  
*Student Last (Family) Name:  
Other names your record may be under:  
*Mailing Address:  
*City:  
*State:  
*Postal Code:  
*Country:  
*Home Phone:  
Work Phone:  
*Email Address:  
Confirmation letters are sent via email. Please provide a valid email address in order to receive your confirmation letter.
*Date of Birth:  
Social Security #
(recommended but not required)		  
U of U Student ID #
(recommended but not required)		  
Are you a Utah Resident? * _____No _____Yes - How many years?_____ months? _____
Ever taken classes at the U of U? _____No _____Yes
Are you an employee at the U? _____No _____Yes
Parent/Guardian Emergency Contact Information (Only required for students age 17 and under.)
First Name:  
Last Name:  
Home Phone:  
Work/Cell Phone:  
Email:  
Relationship:  
Alternate Emergency Contact Information
First Name:  
Last Name:  
Home Phone:  
Work/Cell Phone:  
Email:  
Relationship:  
I certify that I am the legal guardian/parent of this student and I agree to assume responsiblity for course payment. I further agree to sign the waiver of liability the first day of class.
____Yes, please send me information on future Continuing Education courses.
***You are not officially registered for this class until this registration form and complete payment are received by Continuing Education. A spot has not been reserved for you until you are officially registered. To register and pay by phone, please call 801-581-6461.***
You are registering for the following classes: Order Total: $0.00
Term Title Class Section Price
University of Utah continuing education