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Fill this form only to apply for a course. Incomplete applications will not be processed. 

 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 crime ?  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, Monday Jan. 1, 2010. . .

Please provide the following ordering information:

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 the $60 registration fee for the above class.  This registration fee is non-refundable. All students are required to pay a $25 lab fee at the beginning of the course and IT Assistant Level 1 students are required to pay a $150 lab fee that includes the book, tools and the use of the equipment.  You also agree with our class policies.  Project management students will have to pay for their books.
Mattapan Technology Learning Center.
Copyright © 1999 [Town Computer]. All rights reserved.
Revised

 
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