CDISC: Education & Training Registration Form

Note: Please complete this form for each course you are interested in attending, and click Submit Registration. Your information will be submitted to CDISC to confirm your registration and process your payment. See below for CDISC Privacy Information.

Your name:
Organization:
Email address:
Telephone number:
Title of course you wish to attend:
Date of course:

Form of payment:
	American Express
	Visa
	MasterCard
	Check (invoice will be submitted via e-mail)

If paying by credit card, supply the following information (See below for CDISC Privacy Information.):
Name on credit card:
Credit card number:
Expiration date:
Mailing address:

Note: You will receive a confirmation/receipt via e-mail with the total charges per the course selected. If you have any questions, contact Shirley Williams at swilliams@cdisc.org or 512-341-9885.

CDISC Privacy Information

Note: All credit card information collected on the CDISC web site is done so using SSL (Secure Sockets Layer -- the industry standard security protocol), which encrypts your payment information. The information we collect from you when you make an order or register for a course is necessary to process your order, and it is only accessible to CDISC's Administrative staff.

In order to make sure that your order is being handled properly, CDISC may contact you by regular mail, phone or email for any of the following reasons:

To clarify your order or registration,
To clarify your shipping information,
To follow up on your order to determine and improve our services to you.