Welcome To The OMA

Human Relations & Diversity Training
Registration Form


1.Choose a Date

Friday June 19, 2015              12:30 AM - 4:30 PM          Majestic Palm, Boca Campus
Thursday July 16, 2015           12:30 PM - 4:30 PM           Majestic Palm, Boca Campus
Friday July 17, 2015               8:30 AM - 12:30 PM          Majestic Palm, Boca Campus
Friday September 18, 2015       12:30 AM - 4:30 PM         Majestic Palm, Boca Campus
Thursday October 15, 2015        8:30 AM - 12:30 PM         Majestic Palm, Boca Campus
Friday November 20, 2015        12:30 AM - 4:30 PM          Majestic Palm, Boca Campus

 


2.Complete the following information:

Print Name:


Z Number:


Academic College:


Major:


 

Are you currently enrolled this semester?

Yes              No  

 

The Campus where I primarily attend my classes is:

Boca
Davie
Jupiter

 

FAU E-mail:

 

Local Mailing Address:

 

Daytime Phone:

 

Evening/Alt. Phone:

 

Ethnicity:

 

Age/Age Group:

 

Gender:

 

Marital Status:

 

Disability:

 

Faith/Religion:

Other background /self-identification information you would like to share:


  3.Verify and agree to the following:

Enrollment Policy: I am a currently enrolled FAU student, and agree to attend the entire training session from 8:30 a.m. to 12:30 p.m. or 12:30 p.m. to 4:30 p.m. I understand enrollment is limited to 25 students per session and is made on a first-come, first-served basis.

Cancellation Policy: I understand that cancellations must be made in writing and faxed or postmarked at least three business days prior to the training.

Signed:

Date:

 





 Last Modified 6/22/15