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Plymouth State University Community Education Registration Form

Registrations must be received one week prior to the first class meeting to ensure classes are not full or cancelled.


First Name
Last Name:
Birth Date
Gender	Male Female
Address:
City:
State:		Zip:
Home Phone:
Work Phone:
Cell Phone:
Email:
Level of Education:		Other:
Are you a current PSU employee?

I am registering for the following program(s):
CRN #:	Course Name:
CRN #:	Course Name:
CRN #:	Course Name:
CRN #:	Course Name:
*Please Note: Participants are automatically enrolled once payment is received.* Mail completed registration and payment to: Frost School of Continuing and Professional Studies Attn: Tamara Cocchiarella 17 High Street, MSC 10 Plymouth State University Plymouth, NH 03264 Or call 603.535.2822 to pay by credit card.
Photo/Media Release I grant Plymouth State University the right to use, reproduce, assign and/or distribute photographs, films, video tapes and sound recordings of me for use in materials they may crate. Click on check box to approve

Frost School of Continuing and Professional Studies. Speare Administration Building 116. MSC 10. (603) 535-2822. frost_school@plymouth.edu

Plymouth State University. 17 High Street. Plymouth, New Hampshire 03264-1595. Main Switchboard: (603) 535-5000.
A member of the University System of New Hampshire.© 2006-2008. All rights Reserved.
This page was last updated: 4/10/2008