Please provide the following contact information:

First Name
Last Name
Title
Organization
Street
Apt
City
State
Zip Code
Cell Phone
Home Phone
E-mail

Choose the class you prefer:

Thurs. Jan 3rd 10am - Noon Saturday January 19th 5pm - 7pm

How often do you check your email?

Everyday
1 - 3 times a week
1 - 3 times a month

Are you a customer of Town Computer?

Yes No

Name of current employer:

Employer address:

Do you have a computer at home?

Yes No

Do you have Internet at home?

Yes No

Have you ever used Microsoft Word before?

Yes No

Have you ever used Microsoft FrontPage before?

Yes No

What type of web site are you interested in building?

Personal
Professional

Please provide the following payment information:

	BILLING
Credit Card	VISA MasterCard
Cardholder Name
Card Number
Expiration Date
Security Code	(3 digit code found on the back of card in signature box)

	BILLING ADDRESS
Street
Apt
City
State
Zip Code

*  There will be a $100 fee for materials for this training course.  This amount must be paid at the time of registration and must be paid by credit card or debit card.  This fee for materials is non-refundable.  Please enter your initials

*  This free web site design training class is a courtesy of Town Computer.  The training course is 12 weeks long.  Each week will include a lecture and hands-on practice.  We expect you to arrive for the class on time and to attend each class.  If for any reason you are late to class, you may stay only up until the end of your scheduled training class as we have appointments with others at scheduled times.  Please enter your initials

*  If for any reason you miss a class, please call us at (617) 298-0357 to let us know.   If you miss 2 classes during the 12-week course you will not be allowed to continue the training and you will not receive a certificate.  A certificate of completion will be awarded to students who attend the classes regularly and show improvement from week to week.  Please enter your initials

* We expect you to practice at home what you have learned in class and be prepared to ask questions. 

** Town Computer reserves the right to make changes or cancel this offer without notice.