Town Computer Training Application Form

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

Please provide the following contact information:

First Name

Last Name

Middle Initial

Title

Organization

Work Phone

Home Phone

E-mail

Address

City

State Zip Code

Choose one of the following options:

Enter the day of the class you are registering for. For example, Monday, Tuesday . . .

Please provide the following ordering information:

BILLING

Credit Card

Cardholder Name

Card Number

Expiration Date M Y CV 3-digits code

* By submitting this form you agree to have your card charged the $50 registration fee for the above class. This registration fee is non-refundable. IT Assistant Level 1 students are required to pay a $115 lab fee that includes the book, tools and the use of the equipment. You also agree with our class policies. Click here to read our class policies.

First Name
Last Name
Middle Initial
Title
Organization
Work Phone
Home Phone
E-mail

	BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date	M Y CV 3-digits code

	* By submitting this form you agree to have your card charged the $50 registration fee for the above class. This registration fee is non-refundable. IT Assistant Level 1 students are required to pay a $115 lab fee that includes the book, tools and the use of the equipment. You also agree with our class policies. Click here to read our class policies.

Jacques Dady Jean.Copyright © 1999 [Town Computer]. All rights reserved. Revised

Jacques Dady Jean.
Copyright © 1999 [Town Computer]. All rights reserved.
Revised