 |
 |
 |
|||||||||||
|
|||||||||||
      |
| First and Last Name: |
|
| Duke Unique ID: |
____________________________________________________________________ |
| Department: |
____________________________________________________________________ |
| Campus/ DUMC Box #, or Address: |
____________________________________________________________________ |
| Email address: |
____________________________________________________________________ |
| Work Phone: |
__________________ | Home Phone*: |
__________________ |
| *optional - for last minute contacts regarding openings or cancellations | |||
PAYMENT INFORMATION IS REQUIRED
FOR ALL WORKSHOPS, INCLUDING THOSE THAT DO NOT HAVE A
FEE TO COVER POSSIBLE NO-SHOW CHARGES. PLEASE SELECT A FORM OF PAYMENT
BELOW:
Option 1
R/3 SAP Account Code
Company Code (4 digits) __________________________________
Cost Object (formerly "Fund Code:" Campus/7 digits - Health System/9 digits) ______________________________
Option 2
IRI: Please fax this form
with IRI to 613-7621
Option 3
Cash or Check: Take this form
and register in person at our offices at 402 or 406 Oregon Street.
For reasons of security please register online at our secure website, www.hr.duke.edu/train, to pay by credit or procurement card.
Please contact us if you have a disability that would limit or prohibit your participation in a workshop. (613-7613 or learning@mc.duke.edu)
Please enroll me in the following course(s):
| Workshop title | Preferred Start Date |
Alternate Start Date |
Cost |
_________________________________________ |
_______________ |
______________ |
___________ |
_________________________________________ |
_______________ |
______________ |
___________ |
_________________________________________ |
_______________ |
______________ |
___________ |
_________________________________________ |
_______________ |
______________ |
__________ |
Please print out, complete and fax or mail to:
Learning & Organization Development
402/406 Oregon Street
Box 90463
Durham, NC 27708
Telephone: 919-613-7600 |
Fax: 919-613-7621 |
E-Mail: learning@mc.duke.edu