This link will take you to our Secure Online Registration or you may print and complete the form below.
Mail or Fax Registration Form for Tangible Symbol Systems Online Course--Non-credit
First/Middle/Last NAME:
Mailing Address: (course materials will be shipped to this address)

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City/State/Zip:
Work Phone:
Fax: Home Phone:
Email (required):
Credit Card Information:
Your account will be charged $165		 ___ VISA ___ MasterCard ___ Discover ___ AMEX
Account #: Exp.date:
V Code for VISA only (3-digit code at end of number string located on signature strip on back of card: _______
Signature:
Name (as appears on credit card):
Please make checks in the amount of $165 payable to:
Oregon Health & Science University

Mail completed form with payment to:
OHSU Design to Learn Projects
Attn: Carolyn Mills
707 SW Gaines Road
Portland, OR 97239

 Or fax completed form with credit card information to:

(503) 494-2859