Course Registration Form

Last Name: *

First Name: *

MI:

Address:

Phone Number:

Email Address:

Name of Course(s): Please LIST course(s) for wich you wish to register.: *

Do You wish to take this course for credit or personal enrichment (non-credit)?: *

Credit

Personal

Are you currently enrolled in a Consortium college or university?: *

Yes

If yes, which one?:

This registration insures your slot in the course(s) you have chosen. Close to the start date of the course(s) you will receive a college/university course registration and an invoice. Please return to:

Jeanette Schnars

Director,

Regional Science Consortium

Tom Ridge Environmental Center, Suite 9

301 Peninsula Drive

Erie, PA 16505 or

jeanette@RegSciConsort.com

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Course Registration Form