Workforce Development Registration Form

First Name *  

Middle Initial *  

Last Name *  

Last 4 digits of Social Security Number *  

Street/P.O. Box *  

City *  

State *  

Zip Code *  

Email Address: *  

Date of Birth *  

Telephone *  

In case of emergency, notify: *  

at phone: *  

Date Beginning

 

REFUND POLICY: Withdrawal prior to first class meeting, full refund. Withdrawal after class mtg. but prior to second class mtg., 75% refund. After second class meeting, no refund will be given.

Student Signature *  

Date *