Willows SeniorNet

CLASS ONLINE REGISTRATION PROXY


Willows I.D. No.:       {Not Required.}

First Name:        

Last Name:        

Street Address:              

                 City:        

              State:               Zip:                    

           AREA:                Phone:                  

             Email:                 

TWO COURSE CHOICES MAXIMUM.   FORMAT IS: (A)-TAX-003 <----> not course name!

Class C - Workshops cannot be pre-registered using this screen. See "Session Four Mailer" for instructions.

If you wish to register for more than two classes: register for two now, "Submit Form", then run the program again for more.

             Course Choice No. 1:                

             Course Choice No. 2:         

You will be informed of your course assignment information.

If you chose two(2) courses, you will be assigned one OR the other course. Click box to request BOTH courses:

 Pay below for each course.  [1 4-week course = $15.; 2 = $30.][1 8-week course = $20.; 2= $40.]

If you are not a member of SeniorNet, you will be contacted concerning payment.

       Comment:   

EXPECT A WAIT OF UP TO TEN SECONDS AFTER PUSHING THE "SUBMIT FORM" BEFORE NEXT SCREEN COMES UP!


Willow Glen Community and Senior Center

2175 Lincoln Avenue San Jose, CA 95125