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Fill this form only to apply for a course. Incomplete applications will not be processed. If you help filling the registration form call: (617) 298-0357

 Please provide the following contact information:

Privacy statement: Only authorized employees of Town Computer will  have access to information collected from our customers and visitors and will be used strictly for business purposes.

Tell us about yourself:

First Name
Last Name
Middle Initial
Social Security or Driver's License #
Organization
Cell Phone
Home Phone
E-mail
Have you ever convicted for a felony ?  Yes No 
If your answer is yes, explain
 
Please provide your current address:

                   Address

                          City
                          State Zip Code

Choose one of the following options:

                                                                                                

Enter the starting date of the class you are registering for. For example, 10    28    2010

MM  Day Year

Please provide the following ordering information:

Choice # 1 Please charge the $60 Registration fee on my credit card   
Check on the box  to confirm your choice                              
Choice # 2 Please charge the lab and the registration fee on my card   
Check on the box  to confirm your choice                              
BILLING
Credit Card
Cardholder Name
Credit Card #
Expiration Date M Y CV 3-digit code
 
* By submitting this form you agree to have your card charged for amount indicated for the above class.  This registration fee is non-refundable. All students are required to pay a $25 lab fee at the beginning of each course and PC repair/System builder  students are required to pay a $300 lab fee.  You also agree with our class policies.  All students will have to pay separately for their books.
Mattapan Technology Learning Center.
Copyright © 1999 [Town Computer]. All rights reserved.
Revised

 
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