FAX/Mail Registration Form
Registration Instructions:
1) Complete this registration form online.
2) Then print this form out from your computer to your printer.
3) You can then submit this web form to our office either by FAX or by standard mail.
NOTE: This is not an automatic online registration and submission system. For our real-time online registration system, click here.

* Call (702) 895-4195 to submit registration form by FAX (for Credit Card Registrations ONLY)
* Failure to submit ALL of the information on this form to our office will terminate this registration process.

* Mail registration form to our office
* Make checks payable to UNLV Board of Regents
   Mail to: UNLV
                Division of Educational Outreach
                4505 Maryland Parkway
                Box 451019
                Las Vegas, Nevada 89154-1019

Use this form only for credit cards by fax or checks by standard mail.

For other payment options, please do not use this form. Register by phone at
(702) 895-3394

Course #
Course Title
Dates (Month/Day - Month/Day)
Fee
/ to /
$
/ to /
$
/ to /
$
/ to /
$
Please click here to calculate your total registration fees.
Total Registration Fees:
 $

Name of Registrant:  
Student ID# (if returning student and have taken courses in the past): - -

E-mail of Registrant (requested):  E-mail information
Day Phone: ( ) - ext. Home Phone: ( ) -
Mailing Address (Street and Apt.):
City: State: Zipcode: -
Mastercard, VISA, Discover, or Amex Card Number: Exp. Date:
Name on Card:
* Credit Card Information and Payment must be provided at the time the fax is received to confirm registration of courses. Failure to submit this information on this form to our office will terminate this registration process.

Cardholder Signature: _____________________________________________________ (Please sign before faxing this form)

Print this pagePRINT THIS FAX/MAIL REGISTRATION
(After printing, please close this browser window to clear form)
For non-fax registrations, you may print and mail-in this registration form. Please make checks payable to: UNLV Board of Regents. To expedite your registration, please send a separate check for each class.