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REGISTRATION FORM — Spring 2012 

www.allcapecod.org

Cape Cod Community College, Academy for Lifelong learning

2240 Iyannough Road  West Barnstable, MA 02668-1599    

Tel:508.362.2131 x 4400

FOR OFFICE USE ONLY

CK#_______  Amount________

Reg.Forms#1____#2____#3____

Coordinator1____#2____#3____

Legacy_________

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

The best way to contact me is:   By Phone______        By Email______

 

First

Name                                                      Initial:         Last:

Home

Phone:

 

Address:

Cell

Phone:

 

City:                                                                            State:                     Zip:

E

Mail:

 

Date of

Birth:

Emergency

Contact (required)                                                                                                  Phone No: 

 

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❐ 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 in the event preferred courses are full

 

1.ALL:

 

 

 

 

 

 

2.ALL:

 

 

 

 

 

 

3.ALL:

 

 

 

 

 

 

4.ALL:

 

 

 

 

 

Registrations will be processed in the order in which they are received either by postmark or by walk-in delivery. 

The A.L.L. office will be open on Tuesday, January 3rd for mail delivery and hand delivered registration forms.