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Please send payment before start of class to:

Lifelong Learning & Special Programs
S-125 Williams Center
SUNY Fredonia
Fredonia, NY 14063

Make checks payable to SUNY at Fredonia.

Course Title: ____________________________________________

Course Fee:____________ Today's Date: ____________________

Name: _______________________________________________________

Address: ____________________________________________________

City: ______________________ State: ____________ Zip: _______________

Phone Number: __________________ Work Number: _____________________

E-Mail: _____________________________________

Payment: ______Cash _____Check/Money Order _____Visa _____MasterCard

Credit Card #: ____________________________ Expiration Date: ___________ 3-Digit Code:______

Signature: ___________________________________

**SUNY Fredonia does not discriminate on the basis of age, sex, sexual orientation, color, race, marital status, veteran status, disability or religious beliefs. Fees do not include personal health or accident insurance. We reserve the right to change rooms, instructors, times, dates, fees or cancel courses when necessary. No refunds after the start of the course.

Lifelong Learning home page

Lifelong Learning & Special Programs
S-125 Williams Center
SUNY Fredonia
Fredonia, NY 14063
Lifelong.Learning@fredonia.edu
Phone: 716.673.3177 | Fax: 716.673.3652