registration form

Instructions: You can click on the print icon to print this page or go to file menu and click on print sub-menu to print this registration form.

To preregister complete and return this form to 3247 MIDDLEFIELD RD, MENLO PARK, CA 94025. If you are paying by check, please write a separate check for each class (include if the class does not fill. Once you have preregistered for class(es), plan to attend the class unless we notify you by phone that it has been cancelled. NO REFUNDS after the pre-registration deadline has passed. Please read the refund policy.

First Name*

Middle Initial

Last Name*

Day Phone

Evening Phone

Street*

City*

Zip*

Email

Date of Birth*

Soc. Sec. No.

Course No.*

Course Name*

Date/Day/Time*

Fee $*

Course No.*

Course Name*

Date/Day/Time*

Fee $*

Course No.*

Course Name*

Date/Day/Time*

Fee $*

Course No.*

Course Name*

Date/Day/Time*

Fee $*

*Denotes a required field for registration.

Your classes may be paid for with VISA or MasterCard.

Card No.* Expiration Date*

Last 3 digits of pre-printed number in signature line on back of credit card

xxxxYour Signature* ________________________________________
xVISA x MasterCardx

	Registration Information
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