REGISTRATION FORM

Complete this form and mail along with your payment information to:
Gainesville State College
Division of Continuing Education
P. O. Box 1358
Gainesville, GA 30503		 OR

FAX registration form to:
(678) 717-3708.

Name__________________________________________________________________________________________

Address________________________________________________________________________________________

City________________________________________State_________________________ Zip Code______________

County________________________________________

Day Phone(______)______-_______Evening Phone(______)______-________Cell Phone(______)______-_________

E-Mail Address__________________________________________________________________________________

Company Name__________________________________________________________________________________

Company Address________________________________________________________________________________

City_________________________________________State_________________________Zip Code______________

COURSE # COURSE NAME DAY/DATE FEE
       
       
       
       

Cash_________________________________________Check________________________________________

Company Purchase Order#______________________________________________________________________

Authorized Company Representative________________________________________________________________

MasterCard   Visa   Discover      Card#__________________________________Exp Date_____________

Name on Credit Card_____________________________________________________________________________

Please circle t-shirt size for SUMMER "SPORTS" CAMPS:  Child Sizes:  XS    S    M    L     Adult Sizes:  SM   M       L     XL    XXL