Registration Form
Lean Systems Certification

*** This is NOT a secure site. ***
If paying by credit card, you MUST print this form and fax it to us. Fax: 859.257.1071
 

Date
Dr., Ms., etc....
First * Required
Middle Initial
Last * Required
Preference for
Name tag
Job Title
Department
Company * Required
PO Box
Street Address * Required
City * Required
State * Required

Province

County
(if located in KY)
Zip Code * Required
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Business Phone    ext. * Required
   [ex. 555-555-5555]
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Email * Required
Website Address
How did you hear about our program? * Required
  Word of Mouth
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  Email Ad (from the University of Kentucky)
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Lean Systems Certification
$7,500.00 (cost covers all 3 weeks of courses and luncheons each day)
Please select the quarter you wish to attend below.

2010
First Quarter:    
Week 1 - Januray 11-15 Week 2 - February 8-12 Week 3 - March 8-12
     
Second Quarter:    
Week 1 - April 12-16 Week 2 - May 17-21 Week 3 - June 14-18
     
Third Quarter:    
Week 1 - July 19-23 Week 2 - August 16-20 Week 3 - September 13-17
     
Fourth Quarter:    
Week 1 - October 18-22 Week 2 - November 8-12 Week 3 - December 6-10

 

If you have a special
need that may require
accommodation or assistance, please explain:

Payment is made by: 		 
Send invoice to my company    Send invoice to me
Payment/purchase order enclosed 
Purchase order No.


Please make check/purchase order payable to: University of Kentucky

Cancellations made less than 10 days before the course will be subject to the full fee.

*** This is NOT a secure site. ***
If paying by credit card, you MUST print this form and fax it to us. Fax: 859.257.1071

Circle One:

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Security Code________ Billing Address Zipcode _____________
 
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For Course Information Contact:
Ken Kreafle
Email:ken.kreafle@tema.toyota.com
Phone: 859-257-6262, ext. 228
Cell: 859-801-3587

For General Information Contact:
Sandra Dunn
Email:sdunn@engr.uky.edu
Phone: 859-257-6262, ext. 214
Toll Free: 800-227-6268


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