BLS Training Payment Agreement

TRAINING PAYMENT AGREEMENT
Division of International Technical Cooperation
U.S. Bureau of Labor Statistics
Room 2190, 2 Massachusetts Avenue, NE
Washington, DC 20212-0001
Telephone: (202) 691-5666

Fax: (202) 691-5664

E-mail: [email protected]

https://www.bls.gov/ITC

TRAINEE INFORMATION
SURNAME:

GIVEN NAME:

JOB TITLE:
EMPLOYER:
MAILING ADDRESS (Street/PO, City, Country):

TELEPHONE:

FAX:

E-MAIL:

TRAINING AND COST INFORMATION
TRAINING PROGRAM:

DATES OF TRAINING:

TUITION AMOUNT Payable to the Bureau of Labor Statistics (BLS):

$_____________________

Payment, in U.S. dollars, is due before the trainee’s arrival at BLS. Do not include money that should be paid directly to the
trainee including allowances for housing, meals, local transportation, and medical insurance. Please contact [email protected] for
wire transfer information. BLS will only accept payment by check from a U.S. chartered bank.
PAYMENT METHOD:
Wire Transfer

Check

Credit Card

CREDIT CARD INFORMATION (if paying by credit card):
VISA

MasterCard

American Express

Discover

Card Number: ___________________________________________________ Expiration Date: _______________________
Cardholder Name (print clearly): __________________________________________________________________________
Cardholder Signature: ___________________________________________________________________________________
Cardholder Billing Address: ______________________________________________________________________________

FINANCIAL SPONSOR INFORMATION
ORGANIZATION:
MAILING ADDRESS (Street/PO, City, Country):

TELEPHONE:

FAX:

E-MAIL:

PRINT OR TYPE NAME AND TITLE OF OFFICIAL RESPONSIBLE FOR PAYMENT OF TUITION:

SIGNATURE OF OFFICIAL RESPONSIBLE FOR PAYMENT OF TUITION:

DATE: