Non-UW Personnel Radiation Safety Class Registration Form

These ( * ) fields are required.

Non-UW Personnel Radiation Safety Class Registration Form
* First Name:
* Last Name:
* Email:
Department:
UW Box Number: (like '35xxxx')
* UW Phone:
* Class Title:
* Class Date: (like 'mm-dd-yy')
Class Time:
Payment Info (if necessary):
Additional Information: