Willows SeniorNet

WORKSHOPS ONLINE REGISTRATION PROXY


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

First Name:        

Last Name:        

Street Address:              

                 City:        

              State:               Zip:                    

           AREA:                Phone:                  

             Email:                 

WORKSHOP CHOICES MAY BE IN ANY ORDER.   FORMAT IS: (WA)-WRK-001 <----> not workshop name!

See "Session Four Mailer" for instructions.

             Workshop Choice No. 1:                

             Workshop Choice No. 2:         

             Workshop Choice No. 3:         

             Workshop Choice No. 4:         

             Workshop Choice No. 5:         

             Workshop Choice No. 6:         

             Workshop Choice No. 7:         

             Workshop Choice No. 8:         

You will be informed of your workshop assignment information by email.

 Pay below for each workshop.  [1 workshop = $10.; 2 = $20.; 3 = $30.; 4 = $40.; 5 = $50.; 6 = $60.; 7 = $70.; 8 = $80]

       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