We accept checks, purchase orders or credit card payment for trainings that have a registration fee. The course you selected and registered for has a registration fee:
In order to pay by major credit card (Mastercard or Visa only), please PRINT and FAX this form to 206-221-4945 in care of the PTC. You may also call us at 206-685-9850 and give your information to us over the phone. Please do not email your credit card information.
Checks are payable to the University of Washington and can be sent to:
Seattle STD/HIV PTC
901 Boren Ave, Suite 1100
Seattle, WA 98104
Course Information:
Course Name:
Course Fee:
Student Information:
Student's Surname:
Student's First Name:
Type of Credit Card: (check one)
[ ] MasterCard
[ ] Visa
Name As It Appears on Card:
Complete card BILLING address w/ zip
Card Number:
Expiration Date:
Cardholder Signature:
By completing this form, I hereby authorize the University of Washington to
charge my credit card for the above listed amount for STD/HIV training.
Your privacy and security are important to us - your credit card information is kept secure and is destroyed after processing.
HOME
