Continuing Studies
Non-Credit Registration Form
Use this to register for MSUM non-credit workshops

        Workshop Title: ______________________________

            Student's Full Name _____________________________________________

            Name to appear on nametag ______________________ Title__________________

            MSUM ID or SS# _______________________________________________

            Company  _____________________________________________________

            Address _______________________________________________________

            City _______________________ State ________  Zip Code  _____________

            Phone _____________________________________

            Email __________________________________________

        Home Information:

            Street Address __________________________________________________  

            City _______________________ State ________  Zip Code  _____________

            Phone _____________Cell _________________ Email_________________

        Supervisor Information: (If applicable)

            Full Name ______________________________ Title ____________________

            Address if different from above_______________________________________

            Email __________________________________________

        Billing Information:

            [  ]  Registration Fee:  $____________ OR

            [  ]  P.O. # ____________  

        MSUM Payment Information:      

Payment Method (Check One)
[  ] Check (Payable to MSU Moorhead)       [  ] Credit Card (Circle One)   Visa   or   MasterCard   or   Discover

          __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __   Exp __ / __

        Name of Card Holder                                 Signature of Card Holder
        _____________________________        _________________________________
  

Submit form, with payment, in one of the following ways:
1.    Via US Mail to: MSU Moorhead Continuing Studies, PO Box 82, Moorhead, MN 56563
2.    Via fax (Purchase Order or Credit Card): 218.477.5030
3.     In person at: MSU Moorhead Continuing Studies Office, 811 11th St. S., Moorhead, MN 56563
Questions: Call Continuing Studies at 218.477.5862 or email contstdy@mnstate.edu

Cancellation Policy: Registration fees will be reimbursed if cancellation notice is received two weeks prior to class start date or otherwise stated in the course information.

MSU Moorhead is An Equal Opportunity Educator and Employer

Return to Continuing Studies Homepage