NJBIA Course Registration Form

CAMDEN COUNTY COLLEGE

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* 1. Select the course you wish to register for from the drop down box below. To review the course descriptions click here. Please note: Training that is scheduled for 6 hours or more, includes half an hour for lunch.

E-mail Etiquette- June 25, 8:30am-12:30pm

For Camden County College Use Only

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* 2. Name

First

Last

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* 3. Please enter the following information.

Your Job Title

Employer:

Employer Street Address:

Employer City/Town:

Employer State:

Employer ZIP:

Employer County:

Your Email Address:

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* 4. Employer Tax Identification (FEIN) Number (must be 9 digits):

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* 5. Employer DUNS Number

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* 6. Following is required information for reporting purposes.

Cell Phone or Home Phone Number (10 digits, no dashes or spaces)

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* 7. Select your Hourly Wage Code from the drop down box below.

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* 8. The following statement is in accordance with the Higher Education Act. Please read carefully and sign.

I grant permission to the Community College Consortium for Workforce & Economic Development & Member Colleges to share information including the transfer of grades, credits, and other academic records, where applicable, among other organizations and/or agencies/businesses that provide funding for this training. I have secured my employer's approval for attending this course in accordance with the company policy and NJ Department of Labor (funding agency) regulations.

Signature (type full name)

Date (mm/dd/yy)

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* 9. Individuals are permitted to only attend two of the following classes: Change Management, Time Management, or Supervisory Skills in this fiscal year (July 1, 2012 - June 30, 2013). I certify that I have not registered for more than two of these classes beginning July 1, 2012. If I register for more than two of the following classes: Change Management, Time Management, or Supervisory Skills in this fiscal year, I agree to pay $99 for each additional class.

I have read and agree to the terms above.

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* 10. Cancellation Policy: If I am unable to attend the class I registered for, I must notify Camden County College at least seven business days prior to the class date. I understand that if I do not cancel within this time period, my employer or I may incur a $100 cancellation fee. I understand that I have the option to send an eligible participant to attend the class in my place. I will contact CCC with the replacement's contact information within 48 hours before the class date.

Signature (type full name)

Date (mm/dd/yy)

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* 11. Ethnicity (optional)- select from drop down menu below.

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* 12. Gender (optional) - select from drop down menu below.

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* 13. Date of Birth (optional):

Enter your date of birth:

Date

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* 14. THE FOLLOWING INFORMATION IS OPTIONAL

Home Address 1:

Home Address 2:

Home City/Town:

Home State:

Home ZIP:

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* 15. YOU WILL RECEIVE AN EMAIL CONFIRMATION, ONE WEEK PRIOR TO THE CLASS START DATE. Thank you from The New Jersey Community College Consortium.
Scroll to the bottom to "Submit Registration" button.

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* 1. Select the course you wish to register for from the drop down box below. To review the course descriptions click here. Please note: **Training that is scheduled for 6 hours or more, includes half an hour for lunch. **

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* 2. Name

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* 3. Please enter the following information.

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* 4. Employer Tax Identification (FEIN) Number (must be 9 digits):

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* 5. Employer DUNS Number

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* 6. Following is required information for reporting purposes.

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* 7. Select your Hourly Wage Code from the drop down box below.

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* 11. Ethnicity (optional)- select from drop down menu below.

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* 12. Gender (optional) - select from drop down menu below.

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* 13. Date of Birth (optional):

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* 14. THE FOLLOWING INFORMATION IS OPTIONAL

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* 15. YOU WILL RECEIVE AN EMAIL CONFIRMATION, ONE WEEK PRIOR TO THE CLASS START DATE. Thank you from The New Jersey Community College Consortium. Scroll to the bottom to "Submit Registration" button.

* 1. Select the course you wish to register for from the drop down box below. To review the course descriptions click here. Please note: Training that is scheduled for 6 hours or more, includes half an hour for lunch.

* 15. YOU WILL RECEIVE AN EMAIL CONFIRMATION, ONE WEEK PRIOR TO THE CLASS START DATE. Thank you from The New Jersey Community College Consortium.
Scroll to the bottom to "Submit Registration" button.