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Course Registration Form Summer 2011

The document is a course registration form for the Summer 2011 term at Gold LEAF Institute, requiring personal information and course selections. It includes a list of available courses with associated fees and instructions for payment. Membership dues must be paid in full to register for any course, and the form outlines the total amount due and payment methods.

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12 views1 page

Course Registration Form Summer 2011

The document is a course registration form for the Summer 2011 term at Gold LEAF Institute, requiring personal information and course selections. It includes a list of available courses with associated fees and instructions for payment. Membership dues must be paid in full to register for any course, and the form outlines the total amount due and payment methods.

Uploaded by

yard.pro.991
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Course Registration Form

Summer 2011 Term


Note: Use one form per person

Member’s Name ______________________________________________Date ________________

Mailing Address___________________________________________________________________
Street Town State Zip
Telephone # _____________________ E-Mail Address____________________________________
Do you wish to receive informational e-mail messages from Gold LEAF? Yes ______ No______
Do you wish reminders notices: By phone ______ By email ______ No reminders needed ______

Mail Registrations to: Gold LEAF Institute-UMF, 186 High Street, Farmington, ME 04938-6817
(A copy will be sent to the member after the registration process is completed.)

Part 1. Selections: X Select desired course(s) and enter fee amount in the far right-hand column.
Enter
X Course Number/Title Approved * Fee
Fee
1. Polyhedron Origami $6.00
2. Maine Tree Identification $5.50
3. Maritime Adventures on the Coast Pay There xxxx
4. Maine Tales and Places $6.50
5. Farm Day in Franklin County FREE xxxx
6. Wilson Lake Boat Tour $5.50
7. Demystifying Death and Dying $12.00
8. Care and Feeding of Books $5.50
9. Scatterseed Project $2.00
10. Marketing with Facebook $5.50
11. The Benedict Arnold Trail of 1775 Pay There xxxx
12. Beacon Hospice Training FREE xxxx
13. Animal Sheltering 101 $2.00
14. Book Discussion Group $6.50
15. Michael Klahr Center Field Trip $2.00
16. A Force More Powerful $6.50
17. Home Video 101 FREE xxxx
18. A Celtic Arts Evening Pay There xxxx
19. Maintain Your Brain $5.50
20. A Priest and His Tribe $2.00
Course Fees Total
* Refund will be given if class is full or no second session is scheduled. $
Part 2. Membership Dues. Membership must be paid in full to register for any course.
Check one:  New Member ($30)  Renewal ($30) All renewals due by June 30 $

Part 3. Total Amount Due - Make check payable to Gold LEAF Institute – UMF $

Office Use Only (Rev. 1/10)


Payment Method: Check #________________ Dated ___________ Cash Payment ___________
Received by _______________________ Date ____________ Information Recorded _________
Membership Expiration Date _____________ Membership Card Sent: __Yes __N/A Guest pass sent: __Yes __N/A
Original: Office Copy: Member___ Copy: Membership File__

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