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					                             BASIC ADULT COMPUTER EDUCATION SERIES
                                         Registration Form
                                                    JMC Computer Services
                                                     534 North Elm Street
                                                       Troy, Ohio 45373
                                                        (937) 451-2147

Name: _______________________________________________________________________________

Street Address: ________________________________________________________________________

City: ________________________          State: ___________________               Zip Code: __________________

Phone Number: _______________________________

Email Address: ________________________________________________________________________

Reason why you want to take this course: __________________________________________________



Course Name :     { } Computers 101                          { } Office 101

Class number you would like to register for: ______________________________________

Alternate Class number if first choice is full: ______________________________________


Please include this form filled out in full with your course fee and mail it to the address above. We will try everything we can to
accommodate your first selection, if for some reason we cannot we will schedule you in for the alternate class. If you need to
cancel a class for any reason we will gladly refund your money minus a $5.00 registration fee, providing your cancelation is
given to us in writing 48 hours prior to the start of your first class. No refunds will be given for cancelations with less than 48
hours of notice or for no shows to the first class. Registrations and fee’s are not transferable to other people. At our discretion
we may allow for special circumstance in the cancellation policy and allow you to schedule another class at no additional fee’s.

By signing this form and sending in you fee’s you agree to the terms set forth in this registration.

__________________________                                             ____________________

Name                                                                   Date



For Office Use Only:

Date Received________________________                        Class Number Scheduled: ______________________

Verification Letter Sent on: ____________________________________ by: _____________________________

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