Complete this form to sign up for one of Town Computer's Basic Computer Training Class. A $60 registration fee must be paid at the time of registration. This course will meet one time a week, for approximately 10 weeks.
Please provide the following contact information:
First Name Last Name Street Apt.) City State Zip Code Work Phone Home Phone E-mail
Please provide the following employment information:
Company or Organization Name Address City State Zip Code
How long have you worked for this company? (Indicate years or months)
Are you planning to look for a higher position with this company?
Yes No
Are you a customer of Town Computer?
How often do you check your email?
Everyday Once or twice a week Once or twice a month
Do you have a computer at home?
Do you have Internet at home?
Yes No Billing Information Card Holder's Name 16-Digit Card Number Expiration Date / Security Code (The last 3 digits found on the back of credit card) Billing Street Billing City Billing State Billing Zip Code
Billing Information