Registration Form
for Noncredit Online CoursesPrinter friendly formats:
Please send payment before start of class to:
Lifelong Learning and Special Programs
SUNY Fredonia
2148 Fenton Hall
Fredonia, NY 14063
Make checks payable to SUNY Fredonia.
Course Title: _____________________________________
Dates: ____________________
Name: __________________________________________
Address: ________________________________________
City: _____________ State: ______ Zip: _____________
Home Phone: _____________ Work Phone: ____________
E-mail: __________________________________________
Payment: ___ Cash ___ Check ___ Visa ___ MasterCard
Credit Card #: ______________________________
Expiration Date: ___________
Signature: _________________________ Date: ________
