Fax/Mail Registration Form (Academic Credit Courses only)
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.
4) This form is for academic credit courses offered through Educational Outreach only. To register for non-credit or CEU courses please use other form. For all other academic credit courses offered through UNLV, please visit: http://register.unlv.edu
NOTE: This is not an automatic online registration and submission system.

* Fax (702) 895-4195 to submit registration form (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

Please answer following questions:
1) Earned Bachelor's or higher degree? Yes  No
2) Attended UNLV before? Yes   No
3) Gender: Male  Female
4) Birthdate: (required information)

5) Teachers Only: Your School __________________________
Subject Code
Course #
Section #
Course Title
Start Date of Course
Fee
/
$
/
$
/
$
/
$
Please click here to calculate your total registration fees.
Total Registration Fees:
 $
Name of Registrant:  
Student ID# (required on all registrations):
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. Social Security number and birthdate information required on ALL Academic Credit registrations.