SeniorNet of Puget Sound

COMPUTER LEARNING CENTER
 http://www.seniornetps.org

REGISTRATION FORM

 

 

BY MAIL:  Mail-In registrations are processed after they are received, however, in person registration takes priority over mail in registration.  In person registration takes place twice a year. Watch the Newsletter or web site for information.

If not a current member of National Senior Net (required for class registration) printable membership forms are available on our web site, www.seniornetps.org, or call 206-232-5892 to request a form for NEW Membership.

FEES: Only checks, money orders or cash will be accepted for class fees.  DO NOT PAY WITH CASH IF REGISTERING BY MAIL. National SeniorNet membership fees only MAY be charged to your credit card.

**SPECIAL OFFER TO NEW SENIORNET MEMBERSHIPS ONLY**

Deduct $10.00 off your first class

Mail completed forms with remittance to:

SeniorNet of Puget Sound
PMB 705         15600 NE 8th St., Suite B-1             Bellevue, WA 98008-3958

Date:___________________

Name (please print): ____________________________________________________________

Street Address:________________________________________________________________

City, Zip+4: _________________________________ Phone: (      ) ______________________

E-mail Address: _______________________________________________________________

 

To receive our free e-mail Newsletter please check here:  c  

 

Describe prerequisite courses taken or computer experience: ____________________________

_________________________________________________________________________

SeniorNet Membership: New? c          Current Member Expiration Date ___ __ ________________________

 

How did you learn about SeniorNet?   c Newspaper ad      c Catalog     c Newspaper story

c Friend/relative     c Other (please explain) ________________________________                                   4/04

 

COURSE NAMES	COURSE CODES			FEE		Office Use Only
	1st Choice	2nd Choice	3rd Choice			Advisor	Registrar
New SeniorNet Membership (if not charged to credit card)						Receipt Number
Included is my tax–deductible contribution to SeniorNet of Puget Sound
TOTAL