Short Course Registration

international ground water modeling center

Short Course Registration Form

Use the following form to register for a short course
Any questions can be answered by contacting:

International Groundwater Modeling Center
phone: +1 303 273-3103
fax: +1 303 384-2037
email: igwmc@mines.edu

A red asterisk (*) indicates a required field.

Course Name: *

Total Amount:*

Last Name: *

First Name: *

Suffix:

Organization/Company : *

Street Address 1: *

Street Address 2:

City: *

State/Province: *

Country: *

Zip/Postal Code: *

Phone (include country code): *

Fax (include country code):

E-mail Address: *

Payment Option: *

Credit Card
Check
Purchase Order (US Only)

For Credit Card: Please call number above to give us the details.
For Check: Send the check to the address above.
For Purchase Order: Send copy of purchase order to the address above.

IGWMC MAIN PAGE

Last Update: May 1, 2007