Enrichment Registration Form

 

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Enrichment Registration Form

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Valley Unified Continuing Education 728-6314; 834-3536 Office use only Payment: Cash $________ _______ Reg. Book Check $________#________ _______ MaineSTARS Rcpt # _______________ Return Student? Y N Enrichment Registration Form – * * to be completed @ registration Name: _________________________________Date___________ Address: ___________________________ Apt. _____________ Town: ______________________State: ______ Zip: _________ Phone #1: ________________ Phone #2: ___________________ Date of Birth: ____________/__________/_________________ Month / Date / Year Email: ___________________@__________________________ Course Title Start Date Fee (NOTE) $ $ $ TOTAL COST $_________ NOTE: Additional registration fees may be applied for registrations outside the districts. * * See Course catalog. How did you learn about our program? Brochure/Catalog News Letter / Mailing Career Center NEWS AD: SJVT FHF OTH Chamber of Commerce TV AD: WAGM WOWL OTH Facebook WEBSITE: Friend WORK: Instructor OTHER: * * Payment is due at the time of registration to confirm availability.

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