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                       REGISTRATION FORM - FALL 2010

                                          www.allcapecod.org

 

 Cape Cod  Community College, Academy for lifelong learning

 2240 Iyannough Road

 West Barnstable, MA 02668-1599

 508 362 2131 x4400

FOR OFFICE USE ONLY

CK#___________Amount________

CK#_________Family___________

Coordinator 1_____2_____3_____

Legacy______________________

Reg #________________________

 

                Please review the REGISTRATION information in the catalog before completing your form.

 

First Name >                                                   Initial >         Last Name >        

street>                                                                                             town>                                                            zip>

Phone# >                                             Cell >                                                 Birth date (required) >
email address
Emergency Contact Name>                                             Phone#>                                                     relationship>

                                                    

Is this a NEW ADDRESS since your last registration? ❐ Yes ❐ No

 

❐ I am a FIRST TIME member of A.L.L.     How did you learn about A.L.L? __________________________

❐ Single coordinator registration ❐ co-coordinator ❐ tri-coordinator (see registration information) ❐ Legacy Lifetime

Please contact me about “coordinator/assistant coordinator” opportunities. ❐ Yes ❐ No

 

For the $75 tuition fee you may select from the following options. (make check payable to A.L.L.)

 

❐ (4) 6-week courses ▪ ❐ (2) 12-week courses ▪❐ (1) 12-week course & (2) 6-week courses

 

Please list courses in order of preference, including alternate choices. If no alternate choices are listed it is assumed that

none are desired. (Students may join unfilled classes at no additional cost. See “Open Seating” policy.)

off use COURSE #

COURSE NAME (PREFERRED)

 Day Time # WEEKS

(off. use)
  1.ALL:          
  2.ALL:          
  3.ALL:          
  4.ALL:          

ALTERNATE CHOICES
  1.ALL:          
  2.ALL:          
  3.ALL:          
  4.ALL:          

 

Class assignments are made in the order in which registration forms are received. Promptly mail or hand carry your completed form to the A.L.L. office. Be sure to include your check for $75 payable to A.L.L.

Carpoolers taking the same courses may want to mail registration forms in the same envelope. Please indicate who you are carpooling with:____________.