Registration Form

for the course ITC35 Object-Oriented Software Development with UML and Rational Rose

Information Technology Centre, 550 Windsor Street, Fredericton, N.B.

October 18, 19 and 20, 2005

Course registration and payment must be received by Tuesday, October 11, 2005. Course enrollment is limited to 14 students. At least seven course registrants are required for the course to be held. Please fill in the following form and return it (FAX preferable) with payment (see below) to:

Information Technology Centre ITC35

Faculty of Computer Science, University of New Brunswick

P.O. Box 4400, Fredericton, N.B. E3B 5A3

Phone: (506) 447-3220 Fax: (506) 451-6976 E-mail: itc@unb.ca

__________________________________________________________________________________

Name:______________________________________________________________________

Title:_______________________________________________________________________

Affiliation:___________________________________________________________________

Address:____________________________________________________________________

___________________________________________________________________

Telephone number:________________________ Fax number:_________________________

E-mail address: ______________________________________________________________

__________________________________________________________________________________

Registration fee: $1,365 ($1,186.96 + 178.04 HST) [or, “early-bird” discount $1,050 ($913.05 + $136.95 HST), if you register on or before Monday, October 3, 2005]

Registration includes morning coffee, refreshment breaks, lunch, course notes and a reference textbook to keep. Each student has exclusive use of a modern workstation during the hands-on labs. A computer projection system is used for delivering course material.

Method of payment (check one; cheque or money order remitted in Canadian dollars is to be made payable to the "UNB Information Technology Centre"):

o Cheque o Money Order o Purchase Order: PO # _____________________________

Credit Card: o VISA o MasterCard

If Credit Card, please specify

Card Number:___________________________________ Expiration date:________________

Name of Card Holder:_________________________________________________________

(please print or type)

Your Signature:________________________________________ Date signed:_____________

(required for credit card payment)

______________________________________________________________________________________________________________

Optional:

o Please register my Continuing Education Units (CEUs) with the Engineering Institute of Canada

Technical Society or Professional Engineering Association:

_________________________________________________________________________________

Membership Number:_______________________________