REGISTRATION FORM - BRAINTREE COMMUNITY CONTINUING EDUCATION


NAME (FIRST, M.I., LAST):

 

ADDRESS:

 

TOWN & ZIP CODE:

 

HOME PHONE:

 

CELL PHONE:

 

E-MAIL ADDRESS:

 

COURSE NUMBER:

 

COURSE NAME:

 

STATUS (PLEASE CIRCLE ONE):

Adult    Braintree Senior Citizen    Staff

COURSE FEE:

 

CHECK #:

BANK NAME:

AMOUNT ENCLOSED:

 

DAY(S) CLASS MEETS:

Monday       Tuesday       Wednesday       Thursday

A separate form and a separate check for each course.
Please make checks payable to the Town of Braintree.
Mail to: Braintree Community Continuing Education,
Braintree High School, 128 Town Street, Braintree, MA 02184.