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*All adult Community Education courses are for ages 16 and up unless otherwise noted.

Participant’s Information First Name:

Last Name:

Email: Street Address: City:

State:

Zip:

Daytime Phone:

Cell Phone: Receive Email Notifications?

Please check if the participant’s information is a new address, phone number, or email address.

Yes

No

Payer Information (if different than information above) First Name:

Last Name:

Email: Billing Address: City:

State:

Zip:

Phone Number: Course(s) Selected

Fee(s)

Fee(s) Total:

Cash, Check, Money Order, Credit and debit cards (Visa, MasterCard, American Express) accepted. Credit and Debit card payments are to be made online at www.gordonstate.edu/commed. Please make checks and money orders out to Gordon State College.

For More Information: 678-359-5123 • www.gordonstate.edu/commed

Registration

Community Education


Gordon State College Community Education 2016 Fall - Winter 2017