Registration Form

 

Please print and complete this form, and mail to address shown below, or call Telese Forbes at (508) 929-8031.

Name:

Organization:

Address:

City

State

Zip

Telephone

Email

Workshop(s):

Course Number (if applicable):

Cost:

Please enclose check, money order, or Credit Card number and expiration date

Credit Card # (Discover, Visa or MasterCard)

 

Expiration Date:

Name of Cardholder:
Signature: 

Make Checks payable to Worcester State College, and Mail to:

Worcester State College

Center for Business and Industry

Attn: Telese Forbes

486 Chandler Street

Worcester, MA  01602