stars

Registration & Payment Form

Business Education & Training Analysis

715 E 13th Street
Andover, KS 67002
PHONE (316)218–6118 FAX (316)733–4691

First Name
Middle Initial
Last Name
Additional Name
Birth Date (MM/DD/YYYY)
Are you a US Citizen / Permanent Resident?
Yes         No
Gender
Male         Female
 
Permanent Address
Business Address         Personal Address
Street
City
State
Zip
Phone
Alt Phone
Email
Would you like to subscribe to our electronic mail list?
Yes         No
 
What is your race? Select one or more of the following:
American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Are you a Butler Employee?
Yes         No

How did you learn of CWPA and our course offerings?
 
Register in the following courses
Course Offered Course Date
 
PERSONAL PAY
Check Cash Credit
COMPANY PAY
Check Cash Credit
Company Name
If you would like to pay by credit card, please call our office at 316–218–6118
 
INVOICE NEEDED?
 
REFUND POLICY A full refund is given if CWPA cancels a class OR if a participant withdraws at least 7 days prior to the date of the class. A refund, less a $20 Processing Fee, is given if a participant withdraws 2-6 days prior to the date of the class. No refund is given if a participant withdraws less than 48 hours prior to the date of the class.
PAYMENT POLICY Registration constitutes responsibility for payment. Payment by cash or check must be received 7 days prior to the date of the class, unless secured with a credit card. If your employer or organization declines to pay for the class for any reason, you are responsible for payment.
I HAVE READ AND UNDERSTAND THE CWPA REFUND & PAYMENT POLICY STATEMENTS