Registration Form
for Noncredit Online CoursesPrinter friendly formats:
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Please send payment before start of class to:
Lifelong Learning and Special ProgramsS-125 Williams Center
SUNY Fredonia
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: ___________ 3-Digit Code:______
Signature: _________________________ Date: ________