Online Registration Form

So we can process your registration promptly, please:

Use a separate form for each person or program
Complete and submit the online registration form
Be sure to indicate which program you have registered for when submitting your payment
Mail your payment in the form of a check or money order, payable to UW-Eau Claire to the address listed below:

Continuing Education
University of Wisconsin-Eau Claire
P.0. Box 4004
Eau Claire, WI 54702-4004

If you would like to pay with a credit card, please call our office at 715-836-3636 or toll free 1-866-893-2423. Registration is not guaranteed until payment is received

I would like to register for :

*Program Title:

*Date(s) of the program:

Fee of program:

*Name of registrant:

Position/Job Title:

Employing Agency:

Employing Agency Address:

Employing Agency City:

Employing Agency State:

Employing Agency Postal Code:

Employing Agency Phone Number:

(please include area code)

Home Address:

Home City:

Home State:

Home Postal Code:

*Home Phone Number:

(please include area code)

E-mail:

Secondary E-mail:

PO Number if applicable:

Include me in your e-mail mailings: Yes No

Include me on your mailing list: Yes No

*Required fields

It is our policy not to share, sell or distribute the contents of our mailing lists or e-mail lists to organizations outside of the University of Wisconsin-Eau Claire.

Payment of $ will be mailed
Note: Registration is not guaranteed until payment is received.

Questions? Call (715) 836-3636