Lean Six Sigma Green Belt Blended Training Registration Form

Lean Six Sigma Green Belt Blended Training Registration Form Join ASQ to receive the member rates on your courses. DIRECTIONS

To complete your registration and purchase:

• In order to serve you better, please fill out this form completely. • Your registration (whether phoned, faxed, or mailed in) will be confirmed by mail with a receipt and separate confirmation letter. We will make every effort to process your registration within two business days. • If you haven’t received your confirmation within two weeks of sending your registration, or if you need to make any changes, please contact ASQ.

Select the Web-based course that you are registering for.

❑ I learned about the course/seminar(s) I’m registering for through ASQ’s website.

❑ I learned about the course/seminar(s) I’m registering for through a publication that has this PROMO CODE on it.

Promo Code

Member Number: Your member number is required for member price. First Name for Badge: Last Name: First Name:

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COURSE FEE: ❑ Member Price: $3,499 ❑ List/Forum/Division Price: $3,899 ❑ Lean Six Sigma Green Belt — Traditional Version ❑ Lean Six Sigma Green Belt — Healthcare Version ❑ Lean Six Sigma Green Belt — Services Version December 6, 2016 – Virtual Session 1 10:00 a.m. – Noon – Central Time Zone The week of December 12, 2016 – Individual Coaching January 3, 2017 – Virtual Session 2 10:00 a.m. – Noon – Central Time Zone The week of January 9, 2017 – Individual Coaching February 6 – 8, 2017 – 3-Day Classroom Course #9832BLD 8:00 a.m. – 5:00 p.m. – Central Time Zone – Daily The week of February 13, 2017 – Individual Coaching February 21, 2017 – Virtual Session 3 10:00 a.m. – 1:00 p.m. – Central Time Zone (3-Day Classroom Portion of the Course) Premier downtown location on Milwaukee’s riverfront in ASQ Center: ASQ (American Society for Quality) 600 North Plankinton Avenue Milwaukee, WI 53201

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Please submit your order with payment (to submit, a P.O. must be printed on company letterhead) via one of the following options: • Call our Customer Care Center to place your order with a live agent. Monday – Friday 7:00 a.m. – 5:00 p.m. Central – North America: 800-248-1946 (United States and Canada only) – Mexico: 001-800-514-1564 – All other locations: 1-414-272-8575 • Fax to: 414-272-1734 • Mail to: American Society for Quality P.O. Box 3005 Milwaukee, WI 53201-3005 For your protection, email transmittal is prohibited.

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participating in this course the way it was designed—to form a cohort that progresses through the content together, to create a cohesive experience throughout, and to partner with the instructor. Therefore, I agree that transferring to/from any of the virtual or classroom sessions is not in my best interest and will not be permitted. (SVY1)

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PAYMENT INFORMATION:

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❑ Check or money order (U.S. dollars drawn on a U.S. bank).

Make check payable to ASQ. Check Number: ___________________

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❑ Company-issued purchase order (hard copy on company letterhead must accompany registration form). Verbal POs are not allowed. Purchase Order Number * ___________________

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Do you have any special needs, disabilities, and/or dietary restrictions that you would like us to address?

❑ ACH/WIRE payment. Please contact Customer Care if choosing this option. ❑ MasterCard ❑ Visa ❑ American Express

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