We accept checks, purchase orders or credit card payment for trainings that have 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.
PLEASE KEEP THIS FORM FOR YOUR RECORDS - IT IS YOUR RECEIPT
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
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.
PLEASE KEEP THIS FORM FOR YOUR RECORDS - IT IS YOUR RECEIPT
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