Name:
_____________________________________
Address: ____________________________________
____________________________________
Telephone #: (day)
____________________________
(evening)____________________________
E-Mail: ______________________________________
Course(s):/Session
Date/Day Offered
Tuition & Registration Fee
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Total Due: (Tuition & $10.00 Registration
Fee) ________________
(Note: For registrations received after
January 29th there will be a $15.00 fee.)