Registration Form

Name: ___________________________________________________

Address: _________________________________________________

City: ___________________________________Zip:______________

Phone: ______________Work: _____________Cell:________________

* * * * * * * * * * * * * * * * * * * * * * *

____My check is enclosed   CDL# ________________Exp:___________

Please charge my: ___Visa ___MC ___ AmExp ___Disc

Account Number: ___________________________________________

Exp. Date: ______________________3 or 4 Digit Code: ____________

Signature: ________________________________________________

Please enroll me in the following classes:

Name of Class                                                          Date                         Fee       

_________________________________________________________

_________________________________________________________

                                                                        Total Fee:_______________

Classes are not refundable or transferable, please initial: