BCR - Course Registration

Course Registration Form

A receipt for this registration will be sent via email. You can print your registration information after pressing the "Send Registration" button. Approximately one to two weeks prior to the workshop you will receive a second message confirming the workshop's date, time and location.

Please submit this form online. Fields labeled with a red * are required. F³ designates a Free Friday Forum session.

Course Information * Course Title: * Workshop City: Enter Online if appropriate * Workshop State: * Workshop Start Date: (mm/dd/yyyy) If live online, enter the starting date in the box below. If self-paced, please enter “self-paced” in the date box below. Please use the comments box at the bottom of the form to inform us of any other information, clarifications, or requirements that you may need.

Attendee Information * Attendee's First Name: * Attendee's Last Name: * Attendee's Email: * Attendee's Work Phone:

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* Attendee's Home Phone:

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WHY DO WE ASK FOR YOUR HOME PHONE?

Fax:

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Institution Information Institution: * Library: * Billing Address 1: Billing Address 2:(or P.O. Box) * City: * State: * Zip: -

Billing Information

Please indicate your form of payment (required).

OCLC Symbol or BCR billing code: (if known) Look up your OCLC symbol.
Method of Payment: BCR Voucher(s): BCR Online Coupon(s): Purchase Order #:

Finalize Order How did you hear about this workshop?

Will you require ADA accommodations? Yes

Comments: * Name of person completing form: