Community Classroom Series Registration Form - Fall 2008

Payment must accompany this form. Print out and mail or fax to the Friday Center. Please print or type.

Name_____________________________________________________________________________

Mailing Address_____________________________________________________________________

City_________________________________________________State_______Zip________________

Daytime Phone (______)___________________________________

E-mail (please print clearly) ____________________________________________________________

UNC-Chapel Hill uses the Personal ID number (PID) to aid in keeping records for students and participants. If you already have a PID, please enter it. PID #__________________________________________________

If you do not already have a UNC PID, one will be assigned to you. Please provide the following information required for PID number creation:

Gender: M   F     Birth Date______________________________________________________

Are you an alumnus of UNC-Chapel Hill? Yes No. If yes, when did you graduate?_____________

Please indicate the accommodations and/or services you require to participate: ________________________________________________________________________________

List the course(s) you wish to take.  The fee is $50 per course:	Fee
Course name: ______________________________________________ Course #______________	$_________
Course name: ______________________________________________ Course #______________	$_________
Course name: ______________________________________________ Course #______________	$_________
Total enclosed:	$_________

Payment must accompany this form. Make checks payable to the Friday Center (Federal ID#56-6001393). Payments by credit card may be received by mail, fax, or phone.

VISA or MasterCard (Credit card may be received by mail, fax, or phone.)

Mail or fax this form with payment to:
Community Classroom Series Fall 2008
CB 1020, The Friday Center, UNC-Chapel Hill
Chapel Hill, NC 27599-1020
Fax: 919-962-5549