Community education–registration Form
Credit-Free Workshop registration Form reGiSTrATiOn line: (413) 775-1803 GCC Office of Community Education (413) 775-1605 Office of Work Force Development (413) 775-1607 Date: ___/___/____ Semester: Summer 2011 Have you previously attended GCC:
❏ Yes
❏ No
Gender:
❏ Male
❏ Female
My name at that time was: ______________________________________________________________ Name: ______________________________________________________________________________ Date of Birth (required): _____ / _____ / _____ Address:
Student ID
______________________________
____________________________________________________________________________
City: ___________________________________________ State: _____________ Zip: ______________ Home Phone: ______________________________ Work Phone: Cell Phone: ________________________________ Email:
______________________________
____________________________________
CODE __________________ TITLE __________________________PRICE ________________________ CODE __________________ TITLE __________________________PRICE ________________________ CODE __________________ TITLE __________________________PRICE ________________________ Payment method: Check (payable to GCC ) For Credit Card Purchase please call Karen Chastney at (413) 775-1803. Please return this registration form with payment to: Greenfield Community College Community Education One College Drive Greenfield, MA 01301 ATTN: KAREN ❏ 3rd PARTY BILL INFO: ________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
www.gcc.mass.edu
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